Provider Demographics
NPI:1588713218
Name:YORK FAMILY PRACTICE
Entity type:Organization
Organization Name:YORK FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENDZEJEC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-363-8430
Mailing Address - Street 1:16 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-363-8430
Mailing Address - Fax:207-351-3006
Practice Address - Street 1:16 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-363-8430
Practice Address - Fax:207-351-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM4006OtherMEDICARE B
C19364OtherRAILROAD MEDICARE
596163OtherAETNA HMO
596163OtherAETNA NONHMO
YORK083565OtherANTHEM BCBS NEW HAMPSHIRE
596163OtherAETNA HMO
C19364OtherRAILROAD MEDICARE
=========OtherCIGNA HEALTHCARE
=========OtherHARVARD PILGRIM
YORK083565OtherANTHEM BCBS NEW HAMPSHIRE
MM4006OtherMEDICARE B