Healthcare Provider Details

I. General information

NPI: 1750861530
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HOOPER ST
WISCASSET ME
04578-4053
US

IV. Provider business mailing address

PO BOX 745
NEWCASTLE ME
04553-0745
US

V. Phone/Fax

Practice location:
  • Phone: 207-882-7911
  • Fax:
Mailing address:
  • Phone: 207-563-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateME

VIII. Authorized Official

Name: LUGENE ANTHONY INZANA
Title or Position: SENIOR VICE PRESIDENT FINANCE & CFO
Credential:
Phone: 207-662-2654