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General NPI Number Information
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NPI Number | 1164343471
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Entity Type | Organization
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Legal Business Name | WICKED STRONG DIRECT PRIMARY CARE/INTERNAL MEDICINE, PLLC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 144 HIGH ST STE 305
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City | FARMINGTON
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State | ME
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Zip | 04938-1965
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Country | US
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Telephone | 207-544-4319
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Fax | 207-503-7737
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Provider Business Mailing Address
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Address Line | PO BOX 259
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City | STRONG
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State | ME
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Zip | 04983-0259
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Country | US
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Telephone | 207-544-4319
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Fax | 207-503-7737
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STEPHEN GOSS
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Credential | DO
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Telephone | 207-491-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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