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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