Basic Information
| Provider Information | |||||||||
| NPI: | 1134391808 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREAT WORKS FAMILY PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 PORTLAND ST | ||||||||
| Address2: | STE 2A | ||||||||
| City: | SOUTH BERWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039081203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073849212 | ||||||||
| FaxNumber: | 2073842008 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 PORTLAND ST | ||||||||
| Address2: | STE 2A | ||||||||
| City: | SOUTH BERWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039081203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073849212 | ||||||||
| FaxNumber: | 2073899212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | LABONTE | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2073512391 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | YORK HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.