Healthcare Provider Details

I. General information

NPI: 1134295769
Provider Name (Legal Business Name): YORK PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRICKYARD LN SUITE CC
YORK ME
03909-1604
US

IV. Provider business mailing address

1 BRICKYARD LN SUITE CC
YORK ME
03909-1604
US

V. Phone/Fax

Practice location:
  • Phone: 207-361-4902
  • Fax: 207-363-2502
Mailing address:
  • Phone: 207-361-4902
  • Fax: 207-363-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEL WILLIAM KEENAN
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 207-361-4902