Provider Demographics
NPI:1902907983
Name:CALAIS REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:CALAIS REGIONAL HOSPITAL
Other - Org Name:CRH RADIOLOGY PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCADAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-454-7521
Mailing Address - Street 1:43 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1305
Mailing Address - Country:US
Mailing Address - Phone:207-454-8150
Mailing Address - Fax:207-454-0256
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619
Practice Address - Country:US
Practice Address - Phone:207-454-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101960403Medicaid
ME101960403Medicaid