Provider Demographics
NPI:1669423380
Name:MAINEGENERAL MEDICAL CENTER
Entity type:Organization
Organization Name:MAINEGENERAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-1230
Mailing Address - Street 1:P.O BOX 860
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903
Mailing Address - Country:US
Mailing Address - Phone:207-873-9841
Mailing Address - Fax:207-873-9845
Practice Address - Street 1:35 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8160
Practice Address - Country:US
Practice Address - Phone:207-873-9841
Practice Address - Fax:207-873-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37283282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154420000Medicaid
ME1669423380Medicaid
ME154420000Medicaid
ME1669423380Medicaid