1558305847 NPI number — MAINEHEALTH

Table of content: (NPI 1558305847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558305847 NPI number — MAINEHEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINEHEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FCHN NETWORK
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558305847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 FRANKLIN HEALTH COMMONS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04938-6144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-779-2048
Provider Business Mailing Address Fax Number:
207-779-2784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 FRANKLIN HEALTH CMNS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04938-6144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-779-2356
Provider Business Practice Location Address Fax Number:
207-779-2240
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
INZANA
Authorized Official First Name:
LUGENE
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
SVP FINANCE, CFO
Authorized Official Telephone Number:
207-662-3538

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  36464 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003078294 . This is a "CONNECTICUT MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1211234 . This is a "MASSACHUSETTS MEDICAID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900209 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 000018 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 99200037 . This is a "NEW HAMPSHIRE MEDICAID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: M17200 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 01633398 . This is a "NEW YORK MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 101790000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6320200 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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