Provider Demographics
NPI:1629143003
Name:MILES MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MILES MEMORIAL HOSPITAL, INC.
Other - Org Name:MILES GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
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 1:5 MILES CENTER WAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543
Mailing Address - Country:US
Mailing Address - Phone:207-563-4252
Mailing Address - Fax:207-563-4246
Practice Address - Street 1:5 MILES CENTER WAY
Practice Address - Street 2:UNIT 2
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:207-563-4252
Practice Address - Fax:207-563-4246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILES MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0142811799208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200002Medicare PIN
ME200002Medicare Oscar/Certification