Provider Demographics
NPI:1346316973
Name:MILES MEMORIAL HOSPITAL INCORPORATED
Entity Type:Organization
Organization Name:MILES MEMORIAL HOSPITAL INCORPORATED
Other - Org Name:MILES INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-563-4383
Mailing Address - Street 1:5 MILES CENTER WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543
Mailing Address - Country:US
Mailing Address - Phone:207-563-4250
Mailing Address - Fax:207-563-4246
Practice Address - Street 1:5 MILES CENTER WAY
Practice Address - Street 2:UNIT 1
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:207-563-4250
Practice Address - Fax:207-563-4246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILES MEMORIAL HOSPITAL INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200002Medicare PIN