# MAINEHEALTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MAINEHEALTH
- **Other names:** Maine Medical Partners Pediatric Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780981803
- **Legal business name:** MAINEHEALTH
- **Authorized official:** LUGENE ANTHONY INZANA (ASSOCIATE CFO)
- **Authorized official phone:** (207) 662-3538

## Contact information

- **Practice address:** 887 CONGRESS ST, SUITE 300, PORTLAND, ME 04102
- **Practice address phone:** (207) 662-5555
- **Practice address fax:** (207) 662-5526
- **Mailing address:** 22 BRAMHALL ST, PORTLAND, ME 04102-3134
- **Mailing address phone:** (207) 226-6562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |
| 282N00000X | General Acute Care Hospital | 37563 | ME | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | NULL | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/25/2011
- **Last updated:** 12/19/2022