Provider Demographics
NPI:1265460794
Name:ISLANDS COMMUNITY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:ISLANDS COMMUNITY MEDICAL SERVICES INC
Other - Org Name:ISLANDS COMMUNITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-863-4341
Mailing Address - Street 1:15 MEDICAL CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:VINALHAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04863
Mailing Address - Country:US
Mailing Address - Phone:207-863-4341
Mailing Address - Fax:207-863-9358
Practice Address - Street 1:15 MEDICAL CENTER LOOP
Practice Address - Street 2:
Practice Address - City:VINALHAVEN
Practice Address - State:ME
Practice Address - Zip Code:04863
Practice Address - Country:US
Practice Address - Phone:207-863-4341
Practice Address - Fax:207-863-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5389Medicare ID - Type Unspecified
ME201835Medicare Oscar/Certification