Provider Demographics
NPI:1881733905
Name:JACKSON SURGICAL ASSISTING SERVICES LLC.
Entity type:Organization
Organization Name:JACKSON SURGICAL ASSISTING SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - EXECUTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNOR, RNFA
Authorized Official - Phone:207-318-4072
Mailing Address - Street 1:19 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4704
Mailing Address - Country:US
Mailing Address - Phone:207-318-4072
Mailing Address - Fax:207-892-8184
Practice Address - Street 1:19 CURTIS DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4704
Practice Address - Country:US
Practice Address - Phone:207-318-4072
Practice Address - Fax:207-892-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME048931163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty