Healthcare Provider Details

I. General information

NPI: 1275646150
Provider Name (Legal Business Name): MILLINOCKET REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMERSET ST
MILLINOCKET ME
04462-1258
US

IV. Provider business mailing address

200 SOMERSET ST
MILLINOCKET ME
04462-1258
US

V. Phone/Fax

Practice location:
  • Phone: 207-723-5161
  • Fax: 207-723-3028
Mailing address:
  • Phone: 207-723-5161
  • Fax: 207-723-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number36324
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BOB PETERSON
Title or Position: CEO
Credential: CEO
Phone: 207-723-5161