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Contact Information

WATERBORO VILLAGE PEDIATRICS LLC PA
43 SOKOKIS TRAIL
EAST WATERBORO, ME04030
 Phone: 207-247-6742
 Fax: 207-247-6114
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for WATERBORO VILLAGE PEDIATRICS LLC PA

NPI # 1225018740
LBN Legal business name WATERBORO VILLAGE PEDIATRICS LLC PA
Authorized official KEASHA MARESCOT - (CO OWNER PARTNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/19/2006
Last updated 05/07/2008 - About 18 years ago
Identifiers
ME Medicaid 157150000
NH Medicaid 30213870
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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