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General NPI Number Information
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NPI Number | 1124185376
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Entity Type | Organization
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Legal Business Name | ACADIA MEDICAL ARTS ANESTHESIA LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 04/08/2008
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Provider Practice Location 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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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 | MS. PAULETTE A BLUE
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Credential | R.N.
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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