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Penobscot Community Health Center

Organization Active NPI Community/Behavioral Health Agency · Bangor, ME

NPI 1629348156 · NPPES record last updated Aug 6, 2018

Key facts

NPI
1629348156
Entity type
Organization (NPI type 2)
Primary specialty
Community/Behavioral Health Agency 251S00000X
License
611003 (ME)
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Practice address
30 Summer St
Bangor, ME 04401
Phone
(207) 992-2636
Fax
(207) 992-2638
NPI assigned
Dec 30, 2011
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 17

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 6

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 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

National Provider Directory

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 611003 ME Yes

Addresses

Primary practice location

30 Summer St
Bangor, ME 04401

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 945-5247

Other names

  • PCHC Clubhouse Doing business as

Other providers in Bangor, ME

All providers in Bangor, ME · Community/Behavioral Health Agency in Maine

Sources for this page

Verify at the official NPI Registry.