Provider Demographics
NPI:1508052150
Name:HEAD AND NECK SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:HEAD AND NECK SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-797-5753
Mailing Address - Street 1:1250 FOREST AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1889
Mailing Address - Country:US
Mailing Address - Phone:207-797-5753
Mailing Address - Fax:207-878-1715
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1117
Practice Address - Country:US
Practice Address - Phone:207-647-2144
Practice Address - Fax:207-647-2126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAD AND NECK SURGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-18
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========OtherEIN NUMBER
ME152556Medicare PIN