Healthcare Provider Details

I. General information

NPI: 1154477222
Provider Name (Legal Business Name): MAINE SURGICAL ASSISTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 WHITTIER LANE
CASCO ME
04015-0343
US

IV. Provider business mailing address

PO BOX 343
CASCO ME
04015-0343
US

V. Phone/Fax

Practice location:
  • Phone: 207-415-0445
  • Fax: 207-627-6024
Mailing address:
  • Phone: 207-415-0445
  • Fax: 207-627-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number94035
License Number StateME

VIII. Authorized Official

Name: CHRISTINA JEAN JORDAN
Title or Position: OWNER
Credential: CFA
Phone: 207-415-0445