Provider Demographics
NPI:1366453730
Name:PLASTIC & HAND SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:PLASTIC & HAND SURGICAL ASSOCIATES
Other - Org Name:WESTERN AVENUE DAY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-775-3446
Mailing Address - Street 1:244 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2496
Mailing Address - Country:US
Mailing Address - Phone:207-775-3446
Mailing Address - Fax:207-879-1646
Practice Address - Street 1:244 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2496
Practice Address - Country:US
Practice Address - Phone:207-775-3446
Practice Address - Fax:207-879-1646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLASTIC & HAND SURGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208200000X, 2082S0105X, 261QA1903X
ME36164261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107150200Medicaid
MEWE201001Medicare PIN