Provider Demographics
NPI:1790764512
Name:MOUNT DESERT ISLAND HOSPITAL
Entity Type:Organization
Organization Name:MOUNT DESERT ISLAND HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY & COMPLIANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:207-288-5082
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-0008
Mailing Address - Country:US
Mailing Address - Phone:207-288-5081
Mailing Address - Fax:207-288-8620
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-288-5081
Practice Address - Fax:207-288-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QI0500X, 261QM1200X, 261QP2000X, 261QP2300X, 261QR0206X, 261QS0132X, 275N00000X
ME013188282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No251S00000XAgenciesCommunity/Behavioral Health
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200038Medicare PIN
ME20Z304Medicare ID - Type Unspecified
ME201304Medicare ID - Type Unspecified
ME1347980001Medicare NSC