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General NPI Number Information
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NPI Number | 1902422561
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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 | 06/19/2020
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 123 MEDICAL CENTER DR
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City | BRUNSWICK
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State | ME
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Zip | 04011-2652
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Country | US
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Telephone | 207-729-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 123 MEDICAL CENTER DR
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City | BRUNSWICK
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State | ME
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Zip | 04011-2652
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Country | US
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Telephone | 207-729-0181
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Fax |
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Authorized Official
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Title or Position | CFO & MH ASSOCIATE CFO
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Name | LUGENE INZANA
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Credential |
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Telephone | 207-662-2654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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