MEDICARE: MAINEHEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	36424	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295800118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINEHEALTH

Provider Business Mailing Address
First Line	:	PO BOX 309
Second Line	:
City	:	STOCKTON SPRINGS
State	:	ME
Zip	:	04981-0309
Country	:	US
Telephone Number	:	207-567-4000
Fax Number	:	207-567-4084

Provider Business Practice Location Address
First Line	:	CAPE JELLISON ROAD
Second Line	:
City	:	STOCKTON SPRINGS
State	:	ME
Zip	:	04981
Country	:	US
Telephone Number	:	207-567-4000
Fax Number	:	207-567-4084

Authorized Official
Title or Position	:	ASSOCIATE CFO, MAINEHEALTH
Name	:	LUGENE ANTHONY INZANA
Credential	:
Telephone Number	:	207-662-2654

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	10/13/2024

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Directions to “MAINEHEALTH ” Practice Location

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