MEDICARE: CHARLES A DEAN MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	37002	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659388213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES A DEAN MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 1129
Second Line	:	364 PRITHAM AVENUE
City	:	GREENVILLE
State	:	ME
Zip	:	04441-1129
Country	:	US
Telephone Number	:	207-695-5200
Fax Number	:	207-695-2329

Provider Business Practice Location Address
First Line	:	364 PRITHAM AVE
Second Line	:
City	:	GREENVILLE
State	:	ME
Zip	:	04441-1129
Country	:	US
Telephone Number	:	207-695-5215
Fax Number	:	207-695-2329

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANDALL CLARK
Credential	:
Telephone Number	:	207-564-4256

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	10/28/2025

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