Provider Demographics
NPI:1477998466
Name:SEACOAST SURGERY LLC
Entity Type:Organization
Organization Name:SEACOAST SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:THURLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-752-2700
Mailing Address - Street 1:16 HOSPITAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:207-351-8117
Mailing Address - Fax:207-351-8098
Practice Address - Street 1:16 HOSPITAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-351-8117
Practice Address - Fax:207-351-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare PIN