Provider Demographics
NPI:1164668943
Name:PENOBSCOT BAY MEDICAL CENTER
Entity Type:Organization
Organization Name:PENOBSCOT BAY MEDICAL CENTER
Other - Org Name:OUTPATIENT PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE/CORPORATE COMPL
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-594-6757
Mailing Address - Street 1:6 GLEN COVE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4240
Mailing Address - Country:US
Mailing Address - Phone:207-596-8000
Mailing Address - Fax:
Practice Address - Street 1:12 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2739
Practice Address - Country:US
Practice Address - Phone:207-701-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENOBSCOT BAY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-27
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36684282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200063Medicare PIN