MAINE MEDICAL PARTNERS

Provider Demographics

• NPI: 1659351393
• Name: MAINE MEDICAL PARTNERS
• Entity Type: Organization
• Organization Name: MAINE MEDICAL PARTNERS
• Other - Org Name: MAINE MEDICAL PARTNERS NEUROSURGERY & SPINE
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: DIR-PRVDR ENROLLMENT & CVO, MHMG PA
• Authorized Official - First Name: DONNA
• Authorized Official - Last Name: JAUREGUI
• Authorized Official - Phone: 207-661-5414
• Mailing Address - Street 1: 300 SOUTHBOROUGH DR
• Mailing Address - Street 2: SUITE 201
• Mailing Address - City: SOUTH PORTLAND
• Mailing Address - State: ME
• Mailing Address - Zip Code: 04106-6914
• Mailing Address - Country: US
• Mailing Address - Phone: 207-661-2000
• Mailing Address - Fax: 207-661-2033
• Practice Address - Street 1: 92 CAMPUS DRIVE
• Practice Address - Street 2: 1ST FLOOR
• Practice Address - City: SCARBOROUGH
• Practice Address - State: ME
• Practice Address - Zip Code: 04074
• Practice Address - Country: US
• Practice Address - Phone: 207-885-0011
• Practice Address - Fax: 207-883-2586
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-01-19
• Last Update Date: 2022-08-25

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207T00000X	Allopathic & Osteopathic Physicians	Neurological Surgery		Group - Multi-Specialty
No	174400000X	Other Service Providers	Specialist		Group - Multi-Specialty
No	204D00000X	Allopathic & Osteopathic Physicians	Neuromusculoskeletal Medicine & OMM		Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363AS0400X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Surgical	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
ME	130950000	Medicaid
NH	30215114	Medicaid
ME	MM5228	Medicare PIN
ME	130950000	Medicaid
ME	MM5357	Medicare PIN
ME	CA8258	Medicare PIN