Healthcare Provider Details

I. General information

NPI: 1841688942
Provider Name (Legal Business Name): WESTERN AVENUE DAY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROCK ROW STE 210
WESTBROOK ME
04092-4877
US

IV. Provider business mailing address

11 ROCK ROW STE 210
WESTBROOK ME
04092-4877
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-3446
  • Fax: 207-879-1646
Mailing address:
  • Phone: 207-775-3446
  • Fax: 207-879-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number38157
License Number StateME

VIII. Authorized Official

Name: COLETTE BERGERON DAVIES
Title or Position: PRACTICE ADMINISTRATOR
Credential: CPA
Phone: 207-775-3446