Healthcare Provider Details

I. General information

NPI: 1992789184
Provider Name (Legal Business Name): KENNEBEC ANESTHESIA ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PARKWAY STE 201
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PARKWAY STE 201
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-1959
  • Fax: 207-430-4020
Mailing address:
  • Phone: 207-622-1959
  • Fax: 207-430-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDI WHEELER
Title or Position: EXECUTIVE ADMINISTATOR
Credential:
Phone: 207-620-1136