Provider Demographics
NPI:1699860106
Name:MILES MEMORIAL HOSPITAL INCORPORATED
Entity Type:Organization
Organization Name:MILES MEMORIAL HOSPITAL INCORPORATED
Other - Org Name:MILES MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRINTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-563-4476
Mailing Address - Street 1:P.O. BOX 539
Mailing Address - Street 2:
Mailing Address - City:WEST BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04575-0539
Mailing Address - Country:US
Mailing Address - Phone:207-563-1234
Mailing Address - Fax:207-633-1224
Practice Address - Street 1:35 MILES STREET
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:207-563-1234
Practice Address - Fax:207-633-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36359282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101980000Medicaid
ME101980000Medicaid
ME200002Medicare Oscar/Certification