Provider Demographics
NPI:1558305847
Name:MAINEHEALTH
Entity Type:Organization
Organization Name:MAINEHEALTH
Other - Org Name:FCHN NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP FINANCE, 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 1:111 FRANKLIN HEALTH COMMONS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6144
Mailing Address - Country:US
Mailing Address - Phone:207-779-2048
Mailing Address - Fax:207-779-2784
Practice Address - Street 1:111 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-779-2356
Practice Address - Fax:207-779-2240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINEHEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36464282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003078294OtherCONNECTICUT MEDICAID
MA1211234OtherMASSACHUSETTS MEDICAID
ME900209OtherHARVARD PILGRIM
ME000018OtherANTHEM BLUE CROSS
NH99200037OtherNEW HAMPSHIRE MEDICAID
MEM17200OtherCIGNA
NY01633398OtherNEW YORK MEDICAID
ME101790000Medicaid
ME6320200OtherAETNA
NH99200037OtherNEW HAMPSHIRE MEDICAID
ME200037Medicare PIN