Basic Information
| Provider Information | |||||||||
| NPI: | 1740612373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILES MEMORIAL HOSPITAL INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 MILES CENTER WAY | ||||||||
| Address2: | |||||||||
| City: | DAMARISCOTTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045434067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075634250 | ||||||||
| FaxNumber: | 2075634531 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MILES CENTER WAY | ||||||||
| Address2: | |||||||||
| City: | DAMARISCOTTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045434067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075634250 | ||||||||
| FaxNumber: | 2075634531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | PRINTY | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2075634476 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MILES MEMORIAL HOSPITAL INCORPORATED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CNP131061 | ME | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.