NPIMap

Organization Active NPI

Penobscot Community Health Center

Doing business as Jackman Urgent Care Center

  • Urgent Care Clinic/Center
  • Jackman, ME
National Provider Identifier
1366800138
Registry record updated Feb 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Doing business as
Jackman Urgent Care Center
Practice address
376 Main St
Jackman, ME 04945-5214
Phone
(207) 668-7755
NPI assigned
Feb 8, 2016
Last updated
Feb 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2018

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Multi-Specialty Clinic/Center 261QM1300X NU
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

376 Main St
Jackman, ME 04945-5214

Mailing address

PO Box 1599
Bangor, ME 04402-1599

Other names 1

  • Jackman Urgent Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Manna Inc40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

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

View all 39

Locations

376 Main St
Jackman, ME 04945
Phone (207) 668-2691

NPI Registry JSON

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

{
    "created_epoch": "1454889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519257600000",
    "number": "1366800138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 MAIN ST",
            "city": "JACKMAN",
            "state": "ME",
            "postal_code": "049455214",
            "telephone_number": "207-668-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENOBSCOT COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-08",
        "last_updated": "2018-02-22",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "207-992-9200",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackman Urgent Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackman, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; 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.