Healthcare Provider Details

I. General information

NPI: 1811174188
Provider Name (Legal Business Name): AUGUSTA SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CALDWELL RD
AUGUSTA ME
04330-5735
US

IV. Provider business mailing address

16 CALDWELL RD
AUGUSTA ME
04330-5735
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-4116
  • Fax: 207-622-4085
Mailing address:
  • Phone: 207-621-4116
  • Fax: 207-622-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number013601
License Number StateME

VIII. Authorized Official

Name: CAMERON MCKEE
Title or Position: OWNER
Credential: MD
Phone: 207-621-4116