Basic Information
| Provider Information | |||||||||
| NPI: | 1558798165 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LINCOLNHEALTH | ||||||||
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| OtherOrganizationName: | LMP CLINICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 745 | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045530745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075634146 | ||||||||
| FaxNumber: | 2075634103 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 HOOPER ST | ||||||||
| Address2: | |||||||||
| City: | WISCASSET | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045784053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078827911 | ||||||||
| FaxNumber: | 2078826178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2013 | ||||||||
| LastUpdateDate: | 01/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | PRINTY | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2075634476 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.