Provider Demographics
NPI:1407242522
Name:ST. MARY'S REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. MARY'S REGIONAL MEDICAL CENTER
Other - Org Name:ST. MARY'S URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEVERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:207-777-8865
Mailing Address - Street 1:PO BOX 95000 LBX 7650
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:791 TURNER ST
Practice Address - Street 2:UNIT 2
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6314
Practice Address - Country:US
Practice Address - Phone:207-330-3900
Practice Address - Fax:207-330-3940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-15
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38244261QU0200X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care