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General NPI Number Information
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NPI Number | 1407867583
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Entity Type | Organization
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Legal Business Name | ACADIA MEDICAL ARTS AMBULATORY SURGICAL SUITE
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 73 RIDGEWOOD DRIVE
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City | BANGOR
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State | ME
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Zip | 04401
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Country | US
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Telephone | 207-990-0928
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Fax | 207-990-3844
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Provider Business Mailing Address
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Address Line | 73 RIDGEWOOD DRIVE
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City | BANGOR
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State | ME
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Zip | 04401
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Country | US
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Telephone | 207-433-7039
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Fax | 207-990-3844
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELANIE SIBLEY
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Credential |
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Telephone | 207-262-6974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 20C0001007
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License Number State | ME
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