Basic Information
| Provider Information | |||||||||
| NPI: | 1124483433 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH WOODS GENERAL PRACTICE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047763064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073654335 | ||||||||
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| Practice Location | |||||||||
| Address1: | 226 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047763064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073654335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2015 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | HRYNICK | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2073654335 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD11485 | ME | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1124483433 | 05 | ME | MEDICAID | 7172979 | 01 | CIGNA | OTHER | DW4747 | 01 | ME | RAILROAD MEDICARE | OTHER |