Provider Demographics
NPI:1780807446
Name:SEAPORT FAMILY PRACTICE
Entity type:Organization
Organization Name:SEAPORT FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-338-6900
Mailing Address - Street 1:41 WIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6054
Mailing Address - Country:US
Mailing Address - Phone:207-338-6900
Mailing Address - Fax:207-338-4976
Practice Address - Street 1:41 WIGHT ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6054
Practice Address - Country:US
Practice Address - Phone:207-338-6900
Practice Address - Fax:207-338-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117690100Medicaid
ME20-3839Medicare ID - Type Unspecified