Provider Demographics
NPI:1326121294
Name:ACADIA FOOT & ANKLE PA
Entity Type:Organization
Organization Name:ACADIA FOOT & ANKLE PA
Other - Org Name:ACADIA FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-947-2220
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 620
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3667
Mailing Address - Country:US
Mailing Address - Phone:207-947-2220
Mailing Address - Fax:207-947-4073
Practice Address - Street 1:700 MOUNT HOPE AVE STE 620
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3667
Practice Address - Country:US
Practice Address - Phone:207-947-2220
Practice Address - Fax:207-947-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD181213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2646097OtherAETNA
ME135400000Medicaid
ME4763240001Medicare NSC