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Penobscot Community Health Center

Organization Active NPI Community/Retail Pharmacy · Old Town, ME

NPI 1316136302 · NPPES record last updated Jan 19, 2018

Key facts

NPI
1316136302
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
PH50001432 (ME)
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Practice address
242 Brunswick St
Old Town, ME 04468-1613
Phone
(207) 992-4100
Fax
(207) 827-8391
NPI assigned
Oct 16, 2007
Organization subpart
No

Authorized official

Name
Lori L. Dwyer, ESQ.
Title
President & Ceo
Phone
(207) 992-9200

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in ME

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040819000698 ME Part B Supplier - Clinic/Group Practice 0143212670 Receives reassigned benefits from 154 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackman, ME; Old Town, ME; Brewer, ME; Belfast, ME; Bangor, ME
O20160711001550 ME Part B Supplier - Mass Immunization (Roster Biller Only) 0143212670 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Old Town, ME; Belfast, ME; Bangor, ME; Brewer, ME

National Provider Directory

Tax ID family
Penobscot Community Health Care (40 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X PH50001432 ME Yes
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

242 Brunswick St
Old Town, ME 04468-1613

Mailing address

PO Box 2100
Bangor, ME 04402-2100
Phone (207) 945-5247

Other identifiers

IdentifierTypeStateIssuer
131160301MedicaidME
2037653OtherPK

Other providers in Old Town, ME

All providers in Old Town, ME · Community/Retail Pharmacy in Maine

Sources for this page

Verify at the official NPI Registry.