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General NPI Number Information
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NPI Number | 1730779976
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Entity Type | Organization
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Legal Business Name | BLUE HILL HEALTH COLLABORATIVE LLC
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 809 E BLUE HILL RD
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City | BLUE HILL
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State | ME
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Zip | 04614-5414
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Country | US
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Telephone | 201-207-1693
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 42
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City | EAST BLUE HILL
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State | ME
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Zip | 04629-0042
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Country | US
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Telephone | 201-207-1693
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Fax | 207-374-5791
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CARYL JOAN HEATON
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Credential | DO
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Telephone | 201-207-1693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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