Provider Demographics
NPI:1053601864
Name:MAINEHEALTH
Entity type:Organization
Organization Name:MAINEHEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE CFO, MAINEHEALTH
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 1:181 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5664
Mailing Address - Country:US
Mailing Address - Phone:207-743-5933
Mailing Address - Fax:207-743-1566
Practice Address - Street 1:8 PIKES HL
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5340
Practice Address - Country:US
Practice Address - Phone:207-743-9292
Practice Address - Fax:207-743-1578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINEHEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-13
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 282NC0060X, 363LF0000X
ME37353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME203861Medicare Oscar/Certification
ME200032Medicare Oscar/Certification
ME201315Medicare Oscar/Certification