Healthcare Provider Details

I. General information

NPI: 1174449433
Provider Name (Legal Business Name): PHYSICIANS SPECIALISTS SURGERY CENTER OF MAINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BROADWAY
BANGOR ME
04401-5201
US

IV. Provider business mailing address

55 BROADWAY
BANGOR ME
04401-5201
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-5657
  • Fax: 207-947-1894
Mailing address:
  • Phone: 207-947-5657
  • Fax: 207-947-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BRANCH
Title or Position: PRESIDENT
Credential: MD
Phone: 207-947-5657