Provider Demographics
NPI:1730351354
Name:ROYAL RIVER FAMILY CARE, PA
Entity type:Organization
Organization Name:ROYAL RIVER FAMILY CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:207-846-0716
Mailing Address - Street 1:60 FOREST FALLS DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6971
Mailing Address - Country:US
Mailing Address - Phone:207-846-0716
Mailing Address - Fax:207-846-0718
Practice Address - Street 1:60 FOREST FALLS DR
Practice Address - Street 2:SUITE #1
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6971
Practice Address - Country:US
Practice Address - Phone:207-846-0716
Practice Address - Fax:207-846-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME030692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME163380000Medicaid
MEDA2970OtherRAILROAD MEDICARE
ME163380000Medicaid