PENOBSCOT COMMUNITY HEALTH CENTER (NPI# 1740373679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740373679 |
| Entity Type | Organization |
| Organization Name | PENOBSCOT COMMUNITY HEALTH CENTER |
| Other Organization Name | CAPEHART COMMUNITY HEALTH CENTER |
| Practice Address |
86 Davis Rd Bangor ME 04401 |
| Mailing Address |
Po Box 1599 103 Maine Ave Bangor ME 04402-1599 |
| Practice Telephone | 2079922205 |
| Practice Fax Number | 2079922207 |
| Mailing Telephone | 2079455247 |
| Mailing Fax Number | 2079922154 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2018-08-06 |
| Authorized Official Name | LORI L. DWYER (PRESIDENT & CEO) |
| Authorized Official Telephone | 2079929200 |
| Authorized Official Credential | ESQ. |
| Is Organization Subpart | Y |
| Parent Organization Name | PENOBSCOT COMMUNITY HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QC1500X |
Clinic/Center Specialization: Community Health |
Ambulatory Health Care Facilities | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | 131160200 | 05 | |
| MEDICARE GROUP | MM9086 | 01 |
| Other Name | Type Code |
|---|---|
| Capehart Community Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760973960 | Penobscot Community Health Center | Clinic/Center | 1012 Union St Ste 3, Bangor, ME 04401-3058 | 2018-05-23 |
| 1134632870 | Penobscot Community Health Center | Community/Behavioral Health | 85 Hammond St, Bangor, ME 04401-4913 | 2017-11-15 |
| 1720535651 | Penobscot Community Health Center | Dentist | 100 Moosehead Blvd, Bangor, ME 04401 | 2016-09-08 |
| 1174845697 | Penobscot Community Health Center | Clinic/Center | 181 Corporate Drive, Bangor, ME 04401 | 2010-02-25 |
| 1013000942 | Penobscot Community Health Center | General Practice | 79 Parkway S, Brewer, ME 04412 | 2006-10-02 |
| 1831282771 | Penobscot Community Health Center | Family Medicine | 1048 Union St, Suite 5, Bangor, ME 04401-8600 | 2006-10-02 |
| 1922191857 | Penobscot Community Health Center | General Practice | 92 Pendleton St, Brewer, ME 04412 | 2006-10-02 |
| 1659464584 | Penobscot Community Health Center | Family Medicine | 992 Union St. Suite J, Bangor, ME 04402 | 2006-10-02 |
| 1083259410 | Penobscot Community Health Center | Family Medicine | 1068 Union St, Bangor, ME 04401-3016 | 2019-11-08 |
| 1366800138 | Penobscot Community Health Center | Clinic/Center | 376 Main St, Jackman, ME 04945-5214 | 2016-02-08 |
| Street Address |
86 DAVIS RD |
| City | BANGOR |
| State | ME |
| Zip Code | 04401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194784991 | Noah Nesin | Family Medicine | 86 Davis Rd, Bangor, ME 04401-2311 | 2006-03-21 |
| 1386254886 | Timothy Craig Prince | Nurse Practitioner | 86 Davis Rd, Bangor, ME 04401-2311 | 2020-08-09 |
| 1306998281 | James Nelson Riley Sr. | Neuromusculoskeletal Medicine & OMM | 86 Davis Rd, Bangor, ME 04401-2311 | 2007-01-18 |
| 1255416772 | Chrys J. Landrigan | Physician Assistant | 86 Davis Rd, Bangor, ME 04401-2311 | 2006-10-25 |
| 1245323104 | Jennifer A Trimble | Neuromusculoskeletal Medicine & OMM | 86 Davis Rd, Bangor, ME 04401-2311 | 2006-10-02 |
| 1326149725 | Larry P Bolster II | Social Worker | 86 Davis Rd, Bangor, ME 04401 | 2006-09-26 |
| 1093734493 | Constance C Sprague | Registered Nurse | 86 Davis Rd, Bangor, ME 04401-2311 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760973960 | Penobscot Community Health Center | Clinic/Center | 1012 Union St Ste 3, Bangor, ME 04401-3058 | 2018-05-23 |
| 1174845697 | Penobscot Community Health Center | Clinic/Center | 181 Corporate Drive, Bangor, ME 04401 | 2010-02-25 |
| 1992818835 | Intercare Community Health Network | Clinic/Center | 308 Charles St, Bangor, MI 49013 | 2006-08-16 |
| 1326058512 | Intercare Community Health Network | Clinic/Center | 50 Industrial Park Dr, Bangor, MI 49013 | 2006-08-09 |
| 1194133744 | Intercare Community Health Network Dental Van | Clinic/Center | 308 Charles Street, Bangor, MI 49013-1246 | 2014-07-28 |
| 1114335767 | Intercare Community Heath Network Medical Van | Clinic/Center | 308 Charles Street, Bangor, MI 49013-1246 | 2014-07-28 |
| 1639419468 | Penobscot Community Health Center | Clinic/Center | 1012 Union St, Suite 3, Bangor, ME 04401-3060 | 2013-02-14 |
| 1285685628 | Penobscot Community Health Center | Clinic/Center | 6 Telcom Dr, Bangor, ME 04401-3072 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023621273 | Sebasticook Family Doctors | Clinic/Center | 291 Williams Road, Newport, ME 04953 | 2020-08-27 |
| 1295386316 | Community Clinical Services, Inc | Clinic/Center | 1250 Turner St, Auburn, ME 04210-6436 | 2019-09-20 |
| 1679047872 | Portland Community Health Center | Clinic/Center | 52 Frederic St, Portland, ME 04102-2700 | 2019-01-22 |
| 1043783822 | Portland Community Health Center | Clinic/Center | 72 Bishop St, Portland, ME 04102-2957 | 2019-01-04 |
| 1770056558 | Portland Community Health Center | Clinic/Center | 190 Valley Street, Portland, ME 04102-2957 | 2019-01-04 |
| 1700317971 | Portland Community Health Center | Clinic/Center | 28 Portland St, Portland, ME 04101-2912 | 2017-03-21 |
| 1184165367 | Katahdin Valley Health Center | Clinic/Center | 65 South St, Houlton, ME 04730-1550 | 2017-03-20 |
| 1255872537 | Portland Community Health Center | Clinic/Center | 175 Auburn St, Portland, ME 04103-2131 | 2017-03-20 |
| 1881135192 | Portland Community Health Center | Clinic/Center | 353 Cumberland Avenue, Cliff Island, ME 04109-0008 | 2017-03-20 |
| 1669913919 | Katahdin Valley Health Center | Clinic/Center | 48 Penquis Dr, Milo, ME 04463-1033 | 2017-03-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.