Healthcare Provider Details

I. General information

NPI: 1134685019
Provider Name (Legal Business Name): CENTRAL MAINE ORTHOPAEDICS AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 05/31/2024
Certification Date:
Deactivation Date: 05/07/2024
Reactivation Date: 05/31/2024

III. Provider practice location address

690 MINOT AVE STE 4
AUBURN ME
04210-3922
US

IV. Provider business mailing address

690 MINOT AVE STE 4
AUBURN ME
04210-3922
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-1328
  • Fax:
Mailing address:
  • Phone: 207-783-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID B LANDRY
Title or Position: CEO
Credential:
Phone: 207-482-7800