Basic Information
| Provider Information | |||||||||
| NPI: | 1588654479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN MAINE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WHITING HILL RD | ||||||||
| Address2: | FLOOR 5 | ||||||||
| City: | BREWER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044121005 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 489 STATE ST | ||||||||
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| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079737000 | ||||||||
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| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | EDELMAN | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2079738992 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 35999 | ME | N | Hospitals | General Acute Care Hospital | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 101780000 | 05 | ME | MEDICAID |