Provider Demographics
NPI:1912706722
Name:TIDAL RIVER PELVIC HEALTH LLC
Entity type:Organization
Organization Name:TIDAL RIVER PELVIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:E
Authorized Official - Last Name:EICH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-798-9770
Mailing Address - Street 1:963 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579-4303
Mailing Address - Country:US
Mailing Address - Phone:207-798-9770
Mailing Address - Fax:
Practice Address - Street 1:963 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:WOOLWICH
Practice Address - State:ME
Practice Address - Zip Code:04579-4303
Practice Address - Country:US
Practice Address - Phone:207-798-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center