Organization
PENOBSCOT COMMUNITY HEALTH CENTER
Active
Organization
PENOBSCOT COMMUNITY HEALTH CENTER
Active
Other names
Penobscot Community Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
LORI L. DWYER ESQ. (CEO AND PRESIDENT)
(207) 404-8200
Entity
Organization
Contact information
Practice address
1012 UNION ST, BANGOR, ME 04401
(207) 945-5247
(207) 907-7079
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 945-5247
(207) 947-0435
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131160100
—
ME
05
—
131160200
—
ME
Enumeration date
08/31/2006
Last updated
08/06/2018
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