Provider Demographics
NPI:1508988627
Name:HOSPITAL ADMINISTRATIVE DISTRICT 4
Entity Type:Organization
Organization Name:HOSPITAL ADMINISTRATIVE DISTRICT 4
Other - Org Name:GUILFORD MEDICAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIENNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-564-4251
Mailing Address - Street 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-876-3547
Mailing Address - Fax:207-876-3328
Practice Address - Street 1:3 PARK STREET
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:ME
Practice Address - Zip Code:04443
Practice Address - Country:US
Practice Address - Phone:207-876-3547
Practice Address - Fax:207-876-3328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL ADMINISTRATIVE DISTRICT 4
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEC22673OtherRAILROAD MEDICARE
MEDC3866OtherRAILROAD MEDICARE
MEDC3866OtherRAILROAD MEDICARE