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General NPI Number Information
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NPI Number | 1649577768
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Entity Type | Organization
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Legal Business Name | MAINEHEALTH
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 1250 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103
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Country | US
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Telephone | 207-797-5753
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Fax | 207-797-9571
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Provider Business Mailing Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-6562
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE CFO
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Name | LUGENE ANTHONY INZANA
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Credential |
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Telephone | 207-662-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 37563
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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