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General NPI Number Information
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NPI Number | 1063607422
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Entity Type | Organization
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Legal Business Name | ACADIA MEDICAL ARTS PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 404 STATE ST STE 300
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City | BANGOR
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State | ME
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Zip | 04401-6623
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Country | US
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Telephone | 207-990-0928
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Fax | 207-945-4354
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Provider Business Mailing Address
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Address Line | 404 STATE ST STE 200
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City | BANGOR
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State | ME
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Zip | 04401-6652
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Country | US
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Telephone | 207-990-0928
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Fax | 207-945-4354
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PAULETTE A BLUE
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Credential | RN
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Telephone | 207-990-0928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | ME
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