Provider Demographics
NPI:1457514093
Name:MILES MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MILES MEMORIAL HOSPITAL
Other - Org Name:DBA MIILES ANESTHESIA
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:MILLER
Authorized Official - Last Name:FRIANT
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:207-563-4511
Mailing Address - Fax:207-563-4103
Practice Address - Street 1:35 MILES ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4047
Practice Address - Country:US
Practice Address - Phone:207-563-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILES MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEFN1010207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200002Medicare PIN