Healthcare Provider Details

I. General information

NPI: 1124508924
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST
SACO ME
04072-1543
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number37567
License Number StateME

VIII. Authorized Official

Name: LUGENE ANTHONY INZANA
Title or Position: ASSOCIATE CFO
Credential:
Phone: 207-661-1346