Provider Demographics
NPI:1912094806
Name:MAINEHEALTH
Entity Type:Organization
Organization Name:MAINEHEALTH
Other - Org Name:ST. ANDREWS HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSOCIATE CFO, MAINEHEALTH
Authorized Official - Prefix:
Authorized Official - First Name:LUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:INZANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-661-5452
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-0417
Mailing Address - Country:US
Mailing Address - Phone:207-633-2121
Mailing Address - Fax:207-633-5389
Practice Address - Street 1:35 MILES ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4047
Practice Address - Country:US
Practice Address - Phone:207-563-1234
Practice Address - Fax:207-633-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38124282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1912094806-001Medicaid
ME101560000Medicaid
ME1912094806-001Medicaid
ME101560000Medicaid