Healthcare Provider Details

I. General information

NPI: 1992412787
Provider Name (Legal Business Name): BUCKSPORT REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LEJOK ST
ELLSWORTH ME
04605-4767
US

IV. Provider business mailing address

110 BROADWAY
BUCKSPORT ME
04416-4612
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-6054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAROL CAREW
Title or Position: CEO
Credential: RN, BSN, MBA
Phone: 207-469-7371