Healthcare Provider Details

I. General information

NPI: 1316035116
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MILES ST
DAMARISCOTTA ME
04543-4047
US

IV. Provider business mailing address

P.O. BOX 417
BOOTHBAY HARBOR ME
04538-0417
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-1234
  • Fax: 207-633-5389
Mailing address:
  • Phone: 207-633-2121
  • Fax: 207-633-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number38124
License Number StateME

VIII. Authorized Official

Name: LUGENE ANTHONY INZANA
Title or Position: ASSOCIATE CFO, MAINEHEALTH
Credential:
Phone: 207-662-2654