Provider Demographics
NPI:1134299068
Name:BANGOR MEDICAL CENTER INC PC
Entity Type:Organization
Organization Name:BANGOR MEDICAL CENTER INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6100-588-7661
Mailing Address - Street 1:153 N ELEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013
Mailing Address - Country:US
Mailing Address - Phone:610-588-4502
Mailing Address - Fax:610-588-6928
Practice Address - Street 1:153 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1603
Practice Address - Country:US
Practice Address - Phone:610-588-4502
Practice Address - Fax:610-588-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD66376Medicare UPIN
PAB41163Medicare UPIN
PAF33047Medicare UPIN
PAD66290Medicare UPIN