Provider Demographics
NPI:1306141502
Name:SEBASTICOOK FAMILY DOCTORS
Entity type:Organization
Organization Name:SEBASTICOOK FAMILY DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-368-5189
Mailing Address - Street 1:118 MOOSEHEAD TRL
Mailing Address - Street 2:STE 5
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4055
Mailing Address - Country:US
Mailing Address - Phone:207-368-5189
Mailing Address - Fax:207-368-4213
Practice Address - Street 1:71 ELM ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-3121
Practice Address - Country:US
Practice Address - Phone:207-368-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)