1508052150 NPI number — HEAD AND NECK SURGICAL ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508052150 NPI number — HEAD AND NECK SURGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAD AND NECK SURGICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508052150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 FOREST AVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04103-1889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-797-5753
Provider Business Mailing Address Fax Number:
207-878-1715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04009-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-647-2144
Provider Business Practice Location Address Fax Number:
207-647-2126
Provider Enumeration Date:
09/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUTLAND
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
207-797-5753

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)