Provider Demographics
NPI:1053647024
Name:MAINEHEALTH
Entity Type:Organization
Organization Name:MAINEHEALTH
Other - Org Name:MAINE HEMOPHILIA AND THROMBOSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE CFO
Authorized Official - Prefix:
Authorized Official - First Name:LUGENE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:INZANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-662-3538
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:FINANCE DEPARTMENT MGB 1ST FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-3998
Mailing Address - Fax:207-662-6234
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:UNIT 103
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7171
Practice Address - Country:US
Practice Address - Phone:207-885-7683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37025282N00000X
ME37563282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200009Medicare Oscar/Certification