Organization
FISH RIVER RURAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER PELLETIER (CEO)
(207) 444-5973
Entity
Organization
Contact information
Practice address
10 CARTER ST., EAGLE LAKE, ME 04739-0309
(207) 444-5973
(207) 444-5520
Mailing address
10 CARTER ST., PO BOX 309, EAGLE LAKE, ME 04739-0309
(207) 444-5973
(207) 444-5520
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005514
ANTHEM BLUE CROSS SHIELD
ME
05
—
121330001
—
ME
Enumeration date
04/23/2007
Last updated
11/15/2016
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