Healthcare Provider Details

I. General information

NPI: 1821386343
Provider Name (Legal Business Name): KENNEBEC MEDICAL CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 RAILROAD SQ SUITE 2
WATERVILLE ME
04901-6139
US

IV. Provider business mailing address

PO BOX 805
WATERVILLE ME
04903-0805
US

V. Phone/Fax

Practice location:
  • Phone: 207-877-9562
  • Fax: 207-877-9560
Mailing address:
  • Phone: 207-877-9562
  • Fax: 207-877-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2163
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number2163
License Number StateME

VIII. Authorized Official

Name: JERALD E HURDLE
Title or Position: OWNER
Credential: D.O.
Phone: 207-877-9562