Provider Demographics
NPI:1871568766
Name:ROCKOMEKA FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:ROCKOMEKA FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-897-6601
Mailing Address - Street 1:38 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254
Mailing Address - Country:US
Mailing Address - Phone:207-897-6601
Mailing Address - Fax:207-897-4339
Practice Address - Street 1:38 UNION STREET
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254
Practice Address - Country:US
Practice Address - Phone:207-897-6601
Practice Address - Fax:207-897-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME203838Medicare ID - Type Unspecified