Organization
MAINEHEALTH
Active
Other names
MMC Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
LUGENE ANTHONY INZANA (ASSOCIATE CFO)
(207) 662-3538
Entity
Organization
Contact information
Practice address
272 CONGRESS ST, PORTLAND, ME 04101
(207) 761-0650
Mailing address
39 WALLACE AVE, MAINE MEDICAL PARTNERS, SOUTH PORTLAND, ME 04106-6143
(207) 761-0650
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
36236
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102500000
—
ME
01
—
200009000025
ANTHEM BLUE CROSS PROV #
ME
Enumeration date
07/17/2006
Last updated
12/19/2022
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