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General NPI Number Information
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NPI Number | 1487630265
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Entity Type | Organization
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Legal Business Name | THE MAINE SURGICAL CARE GROUP
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 887 CONGRESS ST SUITE 400
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City | PORTLAND
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State | ME
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Zip | 04102-3100
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Country | US
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Telephone | 207-774-6368
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Fax | 207-774-9388
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Provider Business Mailing Address
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Address Line | 887 CONGRESS ST SUITE 400
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City | PORTLAND
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State | ME
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Zip | 04102-3100
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Country | US
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Telephone | 207-774-6368
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Fax | 207-774-9388
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENS ELDRUP-JORGENSEN
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Credential | MD
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Telephone | 207-774-6368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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