Provider Demographics
NPI:1588654479
Name:EASTERN MAINE MEDICAL CENTER
Entity Type:Organization
Organization Name:EASTERN MAINE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-973-8992
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:FLOOR 5
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0700X
ME35999282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101780000Medicaid
ME=========OtherOTHER PAYERS/TAX ID
ME200033Medicare PIN
ME202301Medicare ID - Type UnspecifiedBANGOR RENAL DIALYSIS