Provider Demographics
NPI:1629393327
Name:PINES HEALTH SERVICES
Entity Type:Organization
Organization Name:PINES HEALTH SERVICES
Other - Org Name:ST JOHN VALLEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-498-2356
Mailing Address - Street 1:74 ACCESS HWY
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-3807
Mailing Address - Country:US
Mailing Address - Phone:207-498-2359
Mailing Address - Fax:207-498-3947
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1009
Practice Address - Country:US
Practice Address - Phone:207-868-2796
Practice Address - Fax:207-868-2799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINES HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-06
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201866Medicare Oscar/Certification