Provider Demographics
NPI:1285672436
Name:MAINEGENERAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MAINEGENERAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1817261QE0700X
ME37283282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154420000Medicaid
MEMM6873Medicare ID - Type UnspecifiedGROUP PART B
ME154420000Medicaid