1376546143 NPI number — CALAIS COMMUNITY HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376546143 NPI number — CALAIS COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALAIS COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALAIS COMMUNITY SWING BEDS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376546143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 HOSPITAL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALAIS
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04619-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-454-7521
Provider Business Mailing Address Fax Number:
207-454-3616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 HOSPITAL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALAIS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04619-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-454-7521
Provider Business Practice Location Address Fax Number:
207-454-3616
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PARR
Authorized Official First Name:
LYNNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
207-255-0269

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  36210 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0012304 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 101960100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0439887 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 010211783 . This is a "TRICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 000008 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 900800 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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