Provider Demographics
NPI:1154477222
Name:MAINE SURGICAL ASSISTANTS, PC
Entity Type:Organization
Organization Name:MAINE SURGICAL ASSISTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:CFA
Authorized Official - Phone:207-415-0445
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-0343
Mailing Address - Country:US
Mailing Address - Phone:207-415-0445
Mailing Address - Fax:207-627-6024
Practice Address - Street 1:37 WHITTIER LANE
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:ME
Practice Address - Zip Code:04015-0343
Practice Address - Country:US
Practice Address - Phone:207-415-0445
Practice Address - Fax:207-627-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME94035246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1083763858OtherNPI