Healthcare Provider Details

I. General information

NPI: 1366794513
Provider Name (Legal Business Name): MILLINOCKET REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMERSET ST SUITE 3
MILLINOCKET ME
04462-1258
US

IV. Provider business mailing address

200 SOMERSET ST SUITE 3
MILLINOCKET ME
04462-1258
US

V. Phone/Fax

Practice location:
  • Phone: 207-723-5173
  • Fax: 207-723-3040
Mailing address:
  • Phone: 207-723-5173
  • Fax: 207-723-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MCLAUGHLIN
Title or Position: CFO
Credential:
Phone: 207-723-7231