{
"Npi": {
"NPI": "1508897059",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MAINEHEALTH",
"ParentOrgTIN": null,
"OrgName": "MAINEHEALTH",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "123 ANDOVER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTBROOK",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04092-3848",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-842-6531",
"MailingAddressFaxNumber": "207-842-7773",
"FirstLinePracticeLocationAddress": "216 VAUGHAN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "ME",
"PracticeLocationAddressPostalCode": "04102",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-842-6531",
"PracticeLocationAddressFaxNumber": "207-842-7773",
"EnumerationDate": "07/05/2006",
"LastUpdateDate": "05/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "INZANA",
"AuthorizedOfficialFirstName": "LUGENE",
"AuthorizedOfficialMiddleName": "ANTHONY",
"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "207-661-1346",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "282N00000X",
"TaxonomyName": "General Acute Care Hospital",
"LicenseNumber": "36236",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}