Healthcare Provider Details

I. General information

NPI: 1528359841
Provider Name (Legal Business Name): STEPHENS MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 WINTER ST
NORWAY ME
04268-5620
US

IV. Provider business mailing address

181 MAIN ST
NORWAY ME
04268-5664
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-8031
  • Fax: 207-743-6672
Mailing address:
  • Phone: 207-743-5933
  • Fax: 207-743-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37353
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number37353
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37353
License Number StateME

VIII. Authorized Official

Name: JOHN W COX
Title or Position: SR VP FISCAL
Credential:
Phone: 207-743-5933