Provider Demographics
NPI:1104967884
Name:REGIONAL MEDICAL CENTER AT LUBEC
Entity type:Organization
Organization Name:REGIONAL MEDICAL CENTER AT LUBEC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-733-1090
Mailing Address - Street 1:893 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04630-4051
Mailing Address - Country:US
Mailing Address - Phone:207-255-0102
Mailing Address - Fax:207-255-4645
Practice Address - Street 1:893 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04630-4051
Practice Address - Country:US
Practice Address - Phone:207-255-0102
Practice Address - Fax:207-255-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECO1949261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME167910100Medicaid
ME4618290001OtherMEDICARE DME
MEMM4849Medicare UPIN
ME167910100Medicaid
ME4618290001OtherMEDICARE DME