Basic Information
| Provider Information | |||||||||
| NPI: | 1508823741 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOULTON REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | HOULTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047301891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075322900 | ||||||||
| FaxNumber: | 2075325974 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | HOULTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047301891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075322900 | ||||||||
| FaxNumber: | 2075325974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 01/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | MOAKLER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2075322900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 167890000 | 05 | ME | MEDICAID |