Provider Demographics
NPI:1912160839
Name:SEBASTICOOK VALLEY HOSPITAL
Entity Type:Organization
Organization Name:SEBASTICOOK VALLEY HOSPITAL
Other - Org Name:SEBASTICOOK REGIONAL FAMILY CARE-CARMEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-487-5141
Mailing Address - Street 1:447 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-3707
Mailing Address - Country:US
Mailing Address - Phone:207-487-0916
Mailing Address - Fax:207-487-4585
Practice Address - Street 1:447 MAIN RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:ME
Practice Address - Zip Code:04419-3547
Practice Address - Country:US
Practice Address - Phone:207-848-5846
Practice Address - Fax:207-487-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200028Medicare PIN