Healthcare Provider Details

I. General information

NPI: 1346070117
Provider Name (Legal Business Name): MID-COAST HEALTH NET INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WHITE ST
ROCKLAND ME
04841-2978
US

IV. Provider business mailing address

22 WHITE ST
ROCKLAND ME
04841-2978
US

V. Phone/Fax

Practice location:
  • Phone: 207-301-6996
  • Fax:
Mailing address:
  • Phone: 207-301-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLLE BAADE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 207-520-8823