PENOBSCOT COMMUNITY HEALTH CENTER (NPI# 1366800138) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1366800138 |
Entity Type | Organization |
Organization Name | PENOBSCOT COMMUNITY HEALTH CENTER |
Other Organization Name | JACKMAN URGENT CARE CENTER |
Practice Address |
376 Main St Jackman ME 04945-5214 |
Mailing Address |
Po Box 1599 Bangor ME 04402-1599 |
Practice Telephone | 2076687755 |
Enumeration Date | 2016-02-08 |
Last Update Date | 2018-02-22 |
Authorized Official Name | LORI L. DWYER (PRESIDENT & CEO) |
Authorized Official Telephone | 2079929200 |
Authorized Official Credential | ESQ. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities | ||
N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
Y | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Jackman Urgent Care Center | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760973960 | Penobscot Community Health Center | Clinic/Center | 1012 Union St Ste 3, Bangor, ME 04401-3058 | 2018-05-23 |
1134632870 | Penobscot Community Health Center | Community/Behavioral Health | 85 Hammond St, Bangor, ME 04401-4913 | 2017-11-15 |
1720535651 | Penobscot Community Health Center | Dentist | 100 Moosehead Blvd, Bangor, ME 04401 | 2016-09-08 |
1174845697 | Penobscot Community Health Center | Clinic/Center | 181 Corporate Drive, Bangor, ME 04401 | 2010-02-25 |
1013000942 | Penobscot Community Health Center | General Practice | 79 Parkway S, Brewer, ME 04412 | 2006-10-02 |
1831282771 | Penobscot Community Health Center | Family Medicine | 1048 Union St, Suite 5, Bangor, ME 04401-8600 | 2006-10-02 |
1922191857 | Penobscot Community Health Center | General Practice | 92 Pendleton St, Brewer, ME 04412 | 2006-10-02 |
1659464584 | Penobscot Community Health Center | Family Medicine | 992 Union St. Suite J, Bangor, ME 04402 | 2006-10-02 |
1083259410 | Penobscot Community Health Center | Family Medicine | 1068 Union St, Bangor, ME 04401-3016 | 2019-11-08 |
1275906893 | Penobscot Community Health Center | Podiatrist | 242 Brunswick St, Old Town, ME 04468 | 2015-11-04 |
Street Address |
376 MAIN ST |
City | JACKMAN |
State | ME |
Zip Code | 04945-5214 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407375777 | Town of Jackman | Ambulance | 376 Main St, Jackman, ME 04945-9999 | 2017-09-18 |
1821458506 | Julia B St John | Social Worker | 376 Main St, Jackman, ME 04945 | 2016-02-24 |
1679950463 | Nancy German | Social Worker | 376 Main St, Jackman, ME 04945-5214 | 2015-04-30 |
1669802849 | Penobscot Community Health Center | Clinic/Center | 376 Main St, Jackman, ME 04945 | 2013-11-25 |
1104908300 | Mainegeneral Medical Center | Nursing Facility/Intermediate Care Facility | 376 Main St, Jackman, ME 04945-5214 | 2006-10-19 |
1295787448 | Douglas M Morong | Physician Assistant | 376 Main St, Jackman, ME 04945-5214 | 2006-05-16 |
1255389987 | Anna Babiarz | Physician Assistant | 376 Main St, Jackman, ME 04945-5214 | 2006-05-05 |
1801851654 | Patricia S Doyle | Family Medicine | 376 Main St, Jackman, ME 04945-5214 | 2006-04-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225454531 | Penobscot Community Health Center | Dental Hygienist | 606 Main St, Jackman, ME 04945 | 2014-03-11 |
1487876678 | Maine School Administrative District #12 | Local Education Agency (LEA) | 606 Main Street, Jackman, ME 04945-0239 | 2007-05-03 |
1003123688 | Theresa M. Crawford | Specialist/Technologist | 606 Main St, Jackman, ME 04945-5002 | 2010-09-03 |
1871653949 | North Country Associates, Inc | Intermediate Care Facility, Mentally Retarded | 382 Main St, Jackman, ME 04945-5214 | 2006-12-11 |
Taxonomy Code | 261QU0200X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Urgent Care |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154988707 | Maine Urgent Care, LLC | Clinic/Center | 685 Sabattus Street, Lewiston, ME 04240-0000 | 2019-05-20 |
1093276370 | Convenientmd LLC | Clinic/Center | 193 Bath Road, Brunswick, ME 04011 | 2019-03-28 |
1700355567 | Careall P.C. | Clinic/Center | 230 Waterman Dr, South Portland, ME 04106-3635 | 2018-11-21 |
1992281422 | Convenientmd LLC | Clinic/Center | 543 Broadway, Bangor, ME 04401-3337 | 2018-07-18 |
1821589029 | York Hospital | Clinic/Center | 2 Independence Dr Ste B, Kennebunk, ME 04043-6078 | 2018-05-23 |
1548617780 | Occuaptional Health Centers of The Southwest, P.a. | Clinic/Center | 54 Rumery, Industrial Park, Portland, ME 04106 | 2016-05-18 |
1982051488 | Occuaptional Health Centers of The Southwest, P.a. | Clinic/Center | 1 Idexx Dr, Westbrook, ME 04092-2040 | 2016-05-16 |
1578918132 | Occuaptional Health Centers of The Southwest, P.a. | Clinic/Center | 113 Wells St, North Berwick, ME 03906-6751 | 2016-05-02 |
1437504198 | Occuaptional Health Centers of The Southwest, P.a. | Clinic/Center | 205 Spencer Dr, Wells, ME 04090-5553 | 2016-05-02 |
1366897027 | Occuaptional Health Centers of The Southwest, P.a. | Clinic/Center | 89 Cumberland St, Westbrook, ME 04092-3592 | 2016-05-02 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.