=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588995948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENOBSCOT VALLEY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2010
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 252 ENFIELD RD SUITE 3
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04457-4146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-794-7215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 TRANSALPINE RD
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04457-4222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-794-3321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MELISSA A PELKEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-794-7129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 37453
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------