1104967884 NPI number — REGIONAL MEDICAL CENTER AT LUBEC

Table of content: (NPI 1104967884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104967884 NPI number — REGIONAL MEDICAL CENTER AT LUBEC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL MEDICAL CENTER AT LUBEC
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:
Provider Other Organization Name Type Code:
6
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:
1104967884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
893 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST MACHIAS
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04630-4051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-255-0102
Provider Business Mailing Address Fax Number:
207-255-4645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
893 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST MACHIAS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04630-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-255-0102
Provider Business Practice Location Address Fax Number:
207-255-4645
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
207-733-1090

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  CO1949 , 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: 167910100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4618290001 . This is a "MEDICARE DME" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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