Provider Demographics
NPI:1083635312
Name:PENQUIS CAP, INC.
Entity Type:Organization
Organization Name:PENQUIS CAP, INC.
Other - Org Name:PENQUIS HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-973-3500
Mailing Address - Street 1:262 HARLOW ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4952
Mailing Address - Country:US
Mailing Address - Phone:207-973-3500
Mailing Address - Fax:207-973-3699
Practice Address - Street 1:262 HARLOW ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4952
Practice Address - Country:US
Practice Address - Phone:207-973-3500
Practice Address - Fax:207-973-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPE-MM5771Medicare ID - Type Unspecified