Healthcare Provider Details

I. General information

NPI: 1578690848
Provider Name (Legal Business Name): CENTRAL MAINE ORTHOPAEDICS AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MINOT AVE SUITE ONE
AUBURN ME
04210-3922
US

IV. Provider business mailing address

690 MINOT AVE SUITE ONE
AUBURN ME
04210-3922
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-1315
  • Fax: 207-786-3576
Mailing address:
  • Phone: 207-783-1315
  • Fax: 207-786-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number36418
License Number StateME

VIII. Authorized Official

Name: MATTHEW DONALD BUSH
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 207-783-1328