Basic Information
| Provider Information | |||||||||
| NPI: | 1699860106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MILES MEMORIAL HOSPITAL INCORPORATED | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MILES MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 539 | ||||||||
| Address2: | |||||||||
| City: | WEST BOOTHBAY HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045750539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075631234 | ||||||||
| FaxNumber: | 2076331224 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 MILES STREET | ||||||||
| Address2: | |||||||||
| City: | DAMARISCOTTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075631234 | ||||||||
| FaxNumber: | 2076331224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 02/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | PRINTY | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2075634476 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 36359 | ME | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 101980000 | 05 | ME | MEDICAID |