Provider Demographics
| NPI: | 1083949184 |
|---|---|
| Name: | MAINEGENERAL MEDICAL CENTER |
| Entity type: | Organization |
| Organization Name: | MAINEGENERAL MEDICAL CENTER |
| Other - Org Name: | <UNAVAIL> |
| 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?: | 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
| State | License ID | Taxonomies |
|---|---|---|
| 363L00000X, 2086S0129X, 208G00000X, 208VP0000X, 363A00000X, 2084N0400X, 2084P0800X, 208600000X, 207Y00000X, 208100000X, 207K00000X, 207R00000X | ||
| ME | 37283 | 208800000X, 207X00000X, 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| ME | 200039A | Medicare Oscar/Certification | |
| ME | MM687302 | Medicare PIN |
