Provider Demographics
NPI:1720379977
Name:STEPHENS MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:STEPHENS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:WESTERN MAINE OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP FISCAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-743-5933
Mailing Address - Street 1:181 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5664
Mailing Address - Country:US
Mailing Address - Phone:207-743-5933
Mailing Address - Fax:207-743-1566
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5645
Practice Address - Country:US
Practice Address - Phone:207-743-7605
Practice Address - Fax:207-743-1579
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHENS MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-22
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37353207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201315Medicare Oscar/Certification
ME200032Medicare Oscar/Certification