Provider Demographics
NPI:1679649594
Name:MILES MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MILES MEMORIAL HOSPITAL, INC.
Other - Org Name:MILES PEDIATRICS
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:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:ME
Mailing Address - Zip Code:04553-0745
Mailing Address - Country:US
Mailing Address - Phone:207-563-4780
Mailing Address - Fax:207-563-4713
Practice Address - Street 1:79 SCHOONER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4051
Practice Address - Country:US
Practice Address - Phone:207-563-4780
Practice Address - Fax:207-563-4713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILES MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME208510Medicare Oscar/Certification
200002Medicare PIN