Provider Demographics
NPI:1831112952
Name:MAINEHEALTH
Entity Type:Organization
Organization Name:MAINEHEALTH
Other - Org Name:SOUTHERN MAINE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO & 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:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-0626
Mailing Address - Country:US
Mailing Address - Phone:207-283-7000
Mailing Address - Fax:207-283-7020
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9422
Practice Address - Country:US
Practice Address - Phone:207-283-7000
Practice Address - Fax:207-283-7020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINEHEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37915273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101580000Medicaid
ME20S019Medicare PIN