NPIMap

Organization Active NPI

Millinocket Regional Hospital

Doing business as MRH Primary Care

  • Rural Health Clinic/Center
  • Millinocket, ME
National Provider Identifier
1720330970
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MILLINOCKET REGIONAL HOSPITAL
Doing business as
MRH Primary Care
Practice address
200 Somerset St
Millinocket, ME 04462-1258
Phone
(207) 723-5173
Fax
(207) 723-3346
NPI assigned
Oct 12, 2012
Last updated
Dec 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2012

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

Authorized official

Name
Christine McLaughlin
Title
Cfo
Phone
(207) 723-7231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

200 Somerset St
Millinocket, ME 04462-1258

Mailing address

200 Somerset St
Millinocket, ME 04462-1258
Phone (207) 723-5173

Other names 1

  • MRH Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121221000134 ME Part A Provider - Rural Health Clinic 3779491212 Practice locations: Millinocket, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720330970. Details of each certification follow.

Rural health clinic certification: CCN 208520

Legal name
MILLINOCKET REGIONAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 25, 2013
Last certification
Jan 12, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 1955 in ME
Enrollment address
200 Somerset Street
Millinocket, ME 04462-1258
Related CCNs
201307

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Canham Timothy P Pac2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elizabeth Donley Individual W-2 Managing Employee Nov 20, 2023
Frederick Lewis Individual Corporate Director Mar 25, 2013
Mary Alice Cullen Individual Corporate Director Jul 1, 2023
Edward J Dunstan Individual Corporate Director Mar 25, 2013
Thomas Malcolm Individual Corporate Director Mar 25, 2013
Richard W Angotti Individual Corporate Director Jul 1, 2023
Mellissa a McAvoy Individual Corporate Director Mar 25, 2013
Robert Peterson Individual Corporate OfficerCeo Jun 10, 2014 100%
W-2 Managing Employee Jan 23, 2015
Andrea M Sewall Individual Corporate Director Nov 1, 2022
Shelly Drew Individual W-2 Managing Employee Mar 25, 2013
Gail Fanjoy Individual Corporate Director Mar 25, 2013

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

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": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355270400000",
    "number": "1720330970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SOMERSET ST",
            "city": "MILLINOCKET",
            "state": "ME",
            "postal_code": "044621258",
            "telephone_number": "207-723-5173",
            "fax_number": "207-723-3346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SOMERSET ST",
            "city": "MILLINOCKET",
            "state": "ME",
            "postal_code": "044621258",
            "telephone_number": "207-723-5173",
            "fax_number": "207-723-3346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLINOCKET REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-12",
        "last_updated": "2012-12-12",
        "status": "A",
        "authorized_official_last_name": "MCLAUGHLIN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "207-723-7231"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MRH Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Millinocket, ME

Sources for this page

Verify at the official NPI Registry.