=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699860270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YORK HOSPITAL DBA COASTAL OB-GYN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 01/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 SANFORD ROAD SUITE 2A
-----------------------------------------------------
City | WELLS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-641-8044
-----------------------------------------------------
Fax | 207-641-8169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 810
-----------------------------------------------------
City | WESTBROOK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-854-1544
-----------------------------------------------------
Fax | 207-854-1516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MS. ROBIN LABONTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-351-2391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------