Healthcare Provider Details

I. General information

NPI: 1104967884
Provider Name (Legal Business Name): REGIONAL MEDICAL CENTER AT LUBEC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

893 MAIN ST
EAST MACHIAS ME
04630-4051
US

IV. Provider business mailing address

893 MAIN ST
EAST MACHIAS ME
04630-4051
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-0102
  • Fax: 207-255-4645
Mailing address:
  • Phone: 207-255-0102
  • Fax: 207-255-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberCO1949
License Number StateME

VIII. Authorized Official

Name: MARILYN F HUGHES
Title or Position: CEO
Credential:
Phone: 207-733-1090