Provider Demographics
NPI:1174858278
Name:MAINEGENERAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MAINEGENERAL MEDICAL CENTER
Other - Org Name:MAINEGENERAL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-1230
Mailing Address - Street 1:P.O BOX 860
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903
Mailing Address - Country:US
Mailing Address - Phone:207-872-4454
Mailing Address - Fax:207-872-4467
Practice Address - Street 1:35 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-872-4454
Practice Address - Fax:207-872-4467
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINEGENERAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-07
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 207V00000X, 208000000X, 2084P0800X, 363A00000X, 363L00000X
ME37283282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1174858278Medicaid
ME432678105Medicaid
ME200039AMedicare Oscar/Certification
ME432678105Medicaid