Provider Demographics
NPI:1174671150
Name:ACADIA MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ACADIA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-8876
Mailing Address - Street 1:274 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-1121
Mailing Address - Country:US
Mailing Address - Phone:207-472-1234
Mailing Address - Fax:207-472-1235
Practice Address - Street 1:274 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1121
Practice Address - Country:US
Practice Address - Phone:207-472-1234
Practice Address - Fax:207-472-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134980000Medicaid
ME134980000Medicaid