Basic Information
| Provider Information | |||||||||
| NPI: | 1588713218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YORK FAMILY PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 03909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073638430 | ||||||||
| FaxNumber: | 2073513006 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 03909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073638430 | ||||||||
| FaxNumber: | 2073513006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | JENDZEJEC | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2073638430 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MM4006 | 01 | MEDICARE B | OTHER | C19364 | 01 | RAILROAD MEDICARE | OTHER | 596163 | 01 | AETNA HMO | OTHER | 596163 | 01 | AETNA NONHMO | OTHER | YORK083565 | 01 | ANTHEM BCBS NEW HAMPSHIRE | OTHER |