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General NPI Number Information
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NPI Number | 1134391808
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Entity Type | Organization
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Legal Business Name | GREAT WORKS FAMILY PRACTICE
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 57 PORTLAND ST STE 2A
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City | SOUTH BERWICK
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State | ME
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Zip | 03908-1203
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Country | US
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Telephone | 207-384-9212
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Fax | 207-389-9212
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Provider Business Mailing Address
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Address Line | 57 PORTLAND ST STE 2A
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City | SOUTH BERWICK
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State | ME
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Zip | 03908-1203
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Country | US
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Telephone | 207-384-9212
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Fax | 207-384-2008
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MS. ROBIN LABONTE
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Credential |
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Telephone | 207-351-2391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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