Provider Demographics
NPI:1407364417
Name:MID-COAST HEALTH NET
Entity Type:Organization
Organization Name:MID-COAST HEALTH NET
Other - Org Name:KNOX COUNTY HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-593-1699
Mailing Address - Street 1:22 WHITE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2979
Mailing Address - Country:US
Mailing Address - Phone:207-593-1699
Mailing Address - Fax:
Practice Address - Street 1:1019 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3803
Practice Address - Country:US
Practice Address - Phone:207-593-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental