| Penobscot Community Health Center | |
|
1068 Union St Bangor ME 04401-3016 | |
| (207) 404-8200 | |
| Not Available |
| Full Name | Penobscot Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1068 Union St, Bangor, Maine |
| Authorized Official Name and Position | Lorelle Dwyer (CEO) |
| Authorized Official Contact | 2079929200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Penobscot Community Health Center Po Box 1599 Bangor ME 04402-1599 Ph: (207) 404-8200 | Penobscot Community Health Center 1068 Union St Bangor ME 04401-3016 Ph: (207) 404-8200 |
| NPI Number | 1083259410 |
|---|---|
| Provider Enumeration Date | 11/08/2019 |
| Last Update Date | 11/08/2019 |
| Medicare PECOS PAC ID | 0143212670 |
|---|---|
| Medicare Enrollment ID | O20191211001909 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083259410 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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