Organization
MAINEHEALTH
Active
Parent organization
MAINEHEALTH
Other names
Maine Medical Center, MMC Department of Psychiatry, MaineHealth Maine Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAINEHEALTH
Authorized official
LUGENE ANTHONY INZANA (CFO & ASSOCIATE CFO)
(207) 662-3538
Entity
Organization
Contact information
Practice address
25 JUNE ST, SANFORD, ME 04073-2621
(207) 283-7460
(207) 662-6234
Mailing address
22 BRAMHALL ST, ATTN CASHIERS OFFICE, PORTLAND, ME 04102-3134
(207) 662-6562
(207) 662-6234
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
36236
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102500000
—
ME
01
—
200009000025
ANTHEM BLUE CROSS PROV #
ME
Enumeration date
07/20/2006
Last updated
08/28/2024
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