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General NPI Number Information
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NPI Number | 1578521084
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE HEALTH CARE LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 167 ACADEMY ST STE C
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-3167
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Country | US
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Telephone | 207-764-7200
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Fax | 207-764-7204
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Provider Business Mailing Address
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Address Line | 167 ACADEMY ST STE C
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-3167
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Country | US
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Telephone | 207-764-7200
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Fax | 207-764-7204
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Authorized Official
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Title or Position | CEO
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Name | E. VICTORIA GROVER
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Credential | PA-C
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Telephone | 207-764-7200
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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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