NPIMap

Organization Active NPI

Penobscot Community Health Center

Doing business as PCHC Main Lab

  • Clinical Medical Laboratory
  • Bangor, ME
National Provider Identifier
1659464584
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Doing business as
PCHC Main Lab
Practice address
992 Union St. Suite J
Bangor, ME 04402
Phone
(207) 992-2336
Fax
(207) 992-2154
NPI assigned
Oct 2, 2006
Last updated
Jun 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

992 Union St. Suite J
Bangor, ME 04402

Mailing address

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

Other names 1

  • PCHC Main Lab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Penobscot Community Hea40 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

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1659464584",
    "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",
            "telephone_number": "207-945-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "992 UNION ST. SUITE J",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04402",
            "telephone_number": "207-992-2336",
            "fax_number": "207-992-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENOBSCOT COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2018-06-25",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCHC Main Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.