Waldo County General Hospital

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

36424 Issued in ME

Legal business name

WALDO COUNTY GENERAL HOSPITAL

Practice address

43 West Main Street
Liberty, ME 04949

Phone

(207) 589-4509

Fax

(207) 589-3104

NPI assigned

Nov 24, 2006

Organization subpart

Yes

Parent organization

WALDO COUNTY GENERAL HOSPITALAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gordon L Tibbetts

Title

Cfo

Phone

(207) 338-2500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Donald S. Walker Health Center Doing business as

Part of

Stockton Springs Region

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1164598090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WEST MAIN STREET",
            "city": "LIBERTY",
            "state": "ME",
            "postal_code": "04949",
            "telephone_number": "207-589-4509",
            "fax_number": "207-589-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 WEST MAIN STREET",
            "city": "LIBERTY",
            "state": "ME",
            "postal_code": "04949",
            "telephone_number": "207-589-4509",
            "fax_number": "207-589-3104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDO COUNTY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALDO COUNTY GENERAL HOSPITAL",
        "enumeration_date": "2006-11-24",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "TIBBETTS",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "207-338-2500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ME",
            "license": "36424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101570202",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Donald S. Walker Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aaron Everett Mitschke, FNP
• Painted Horses LLC
• Valerie L Poulos, PA-C
• Julio Gonzalez Santana, CMA
• Town of Liberty
• Donna Lynn Walsh, MS,RD
• Steven G Wilson, M.D.

• Rural Health Clinic/Center in Liberty, ME
• Providers in Liberty, ME by specialty
• Rural Health Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.