1518064047 NPI number — MOUNT DESERT ISLAND 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 1518064047 NPI number — MOUNT DESERT ISLAND HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT DESERT ISLAND 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:
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:
1518064047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 WAYMAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAR HARBOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04609-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-288-5082
Provider Business Mailing Address Fax Number:
207-288-8620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 COMMUNITY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHWEST HARBOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04679-4273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-244-2888
Provider Business Practice Location Address Fax Number:
207-244-0490
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABBOTT
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
DIRECTOR OF MEDICAL STAFF SUPPORT
Authorized Official Telephone Number:
207-288-5081

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 1347980001 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1347980001 . This is a "DME SUPPLIER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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