Provider Demographics
NPI:1609958644
Name:MILES MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MILES MEMORIAL HOSPITAL, INC.
Other - Org Name:MMG WISCASSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:MS
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 1:49 HOOPER ST
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-4053
Mailing Address - Country:US
Mailing Address - Phone:207-882-7911
Mailing Address - Fax:207-882-6178
Practice Address - Street 1:49 HOOPER ST
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-4053
Practice Address - Country:US
Practice Address - Phone:207-882-7911
Practice Address - Fax:207-882-6178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILES MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200002Medicare PIN
ME200002Medicare Oscar/Certification