Provider Demographics
NPI:1699975078
Name:OSTEOPATHIC CENTER FOR FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:OSTEOPATHIC CENTER FOR FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-945-5400
Mailing Address - Street 1:603 MAIN RD N
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 MAIN RD N
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1804
Practice Address - Country:US
Practice Address - Phone:207-945-5400
Practice Address - Fax:866-463-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME1760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH99318Medicare UPIN
ME0002751Medicare PIN