Provider Demographics
NPI:1790764512
Name:MOUNT DESERT ISLAND HOSPITAL
Entity type:Organization
Organization Name:MOUNT DESERT ISLAND HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY & COMPLIANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:207-288-5082
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-0008
Mailing Address - Country:US
Mailing Address - Phone:207-288-5081
Mailing Address - Fax:207-288-8620
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-288-5081
Practice Address - Fax:207-288-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X, 261QP2300X, 261QR0206X, 261QS0132X, 261QP2000X, 251S00000X, 261QI0500X, 261QM1200X
ME013188282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251S00000XAgenciesCommunity/Behavioral Health
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200038Medicare PIN
ME20Z304Medicare ID - Type Unspecified
ME201304Medicare ID - Type Unspecified
ME1347980001Medicare NSC