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General NPI Number Information
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NPI Number | 1760436216
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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 | 05/20/2006
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Last Update Date | 11/26/2024
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Provider Practice Location 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
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Country | US
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Telephone | 207-662-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 22 BRAMHALL ST ATTENTION: CASHIERS OFFICE
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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 | 207-662-0111
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Fax |
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Authorized Official
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Title or Position | CFO & ASSOCIATE CFO
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Name | LUGENE ANTHONY INZANA
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Credential |
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Telephone | 207-661-7183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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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 | 36236
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License Number State | ME
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