Healthcare Provider Details

I. General information

NPI: 1609958644
Provider Name (Legal Business Name): MILES MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HOOPER ST
WISCASSET ME
04578-4053
US

IV. Provider business mailing address

49 HOOPER ST
WISCASSET ME
04578-4053
US

V. Phone/Fax

Practice location:
  • Phone: 207-882-7911
  • Fax: 207-882-6178
Mailing address:
  • Phone: 207-882-7911
  • Fax: 207-882-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. STACEY A. MILLER
Title or Position: VP PHYSICIAN SERVICES
Credential:
Phone: 207-563-4383