Healthcare Provider Details

I. General information

NPI: 1841735297
Provider Name (Legal Business Name): PENOBSCOT BAY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GLEN COVE DRIVE
ROCKPORT ME
04856
US

IV. Provider business mailing address

4 WHITE STREET
ROCKLAND ME
04841
US

V. Phone/Fax

Practice location:
  • Phone: 207-921-8390
  • Fax: 207-921-5286
Mailing address:
  • Phone: 207-921-6750
  • Fax: 207-921-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: LINDA B. DRINKWATER
Title or Position: REGIONAL CFO
Credential:
Phone: 207-921-6721