Healthcare Provider Details

I. General information

NPI: 1174671150
Provider Name (Legal Business Name): ACADIA MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 MAIN ST
FORT FAIRFIELD ME
04742-1121
US

IV. Provider business mailing address

1019 TOWN DR
HIGHLAND HEIGHTS KY
41076-9114
US

V. Phone/Fax

Practice location:
  • Phone: 207-472-1234
  • Fax: 207-472-1235
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B00000X
License Number StateME

VIII. Authorized Official

Name: GREGORY J CRAWFORD
Title or Position: CEO
Credential:
Phone: 859-300-6455