Provider Demographics
NPI:1831312313
Name:MICMAC HEALTH DEPARTMENT
Entity type:Organization
Organization Name:MICMAC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-7219
Mailing Address - Street 1:8 NORTHERN RD
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2040
Mailing Address - Country:US
Mailing Address - Phone:207-764-7219
Mailing Address - Fax:207-764-7768
Practice Address - Street 1:8 NORTHERN RD
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2040
Practice Address - Country:US
Practice Address - Phone:207-764-7219
Practice Address - Fax:207-762-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124390000Medicaid