Organization
PENOBSCOT COMMUNITY HEALTH CENTER
Active
Parent organization
PENOBSCOT COMMUNITY HEALTH CENTER
Other names
Capehart Community Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Authorized official
LORI L. DWYER ESQ. (PRESIDENT & CEO)
(207) 992-9200
Entity
Organization
Contact information
Practice address
86 DAVIS RD, BANGOR, ME 04401
(207) 992-2205
(207) 992-2207
Mailing address
PO BOX 1599, 103 MAINE AVE, BANGOR, ME 04402-1599
(207) 945-5247
(207) 992-2154
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131160200
—
ME
01
—
MM9086
MEDICARE GROUP
—
Enumeration date
10/02/2006
Last updated
08/06/2018
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