Healthcare Provider Details

I. General information

NPI: 1184716094
Provider Name (Legal Business Name): WESTERN MOUNTAIN SURGICAL CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 LIVERMORE FALLS RD SUITE 1
FARMINGTON ME
04938-9654
US

IV. Provider business mailing address

167 LIVERMORE FALLS RD SUITE 1
FARMINGTON ME
04938-9654
US

V. Phone/Fax

Practice location:
  • Phone: 207-778-6579
  • Fax: 207-778-6409
Mailing address:
  • Phone: 207-778-6579
  • Fax: 207-778-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number006233
License Number StateME

VIII. Authorized Official

Name: DAVID C DIXON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 207-778-6579