Provider Demographics
NPI:1093854069
Name:SEBASTICOOK VALLEY PRIMARY CARE
Entity type:Organization
Organization Name:SEBASTICOOK VALLEY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAETANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-487-5071
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:140 CHANDLER STREET
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-0515
Mailing Address - Country:US
Mailing Address - Phone:207-487-9244
Mailing Address - Fax:207-487-2834
Practice Address - Street 1:140 CHANDLER STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-0515
Practice Address - Country:US
Practice Address - Phone:207-487-9244
Practice Address - Fax:207-487-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME023158OtherDR. HUOT STAR ID
ME024866OtherANTHEM STAR ID
F94301Medicare UPIN
H83866Medicare UPIN
MEMM6964Medicare ID - Type UnspecifiedMEDICARE ID