Healthcare Provider Details

I. General information

NPI: 1548355654
Provider Name (Legal Business Name): MILES MEMORIAL HOSPITAL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MILES ST
DAMARISCOTTA ME
04543-4047
US

IV. Provider business mailing address

PO BOX 539
WEST BOOTHBAY HARBOR ME
04575-0539
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-1234
  • Fax: 207-633-1224
Mailing address:
  • Phone: 207-563-1234
  • Fax: 207-633-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number36359
License Number StateME

VIII. Authorized Official

Name: WAYNE R PRINTY
Title or Position: CFO
Credential:
Phone: 207-563-4476