Healthcare Provider Details

I. General information

NPI: 1487630265
Provider Name (Legal Business Name): THE MAINE SURGICAL CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST SUITE 400
PORTLAND ME
04102-3100
US

IV. Provider business mailing address

887 CONGRESS ST SUITE 400
PORTLAND ME
04102-3100
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-6368
  • Fax: 207-774-9388
Mailing address:
  • Phone: 207-774-6368
  • Fax: 207-774-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENS ELDRUP-JORGENSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 207-774-6368