Provider Demographics
NPI:1407867583
Name:ACADIA MEDICAL ARTS AMBULATORY SURGICAL SUITE
Entity Type:Organization
Organization Name:ACADIA MEDICAL ARTS AMBULATORY SURGICAL SUITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-262-6974
Mailing Address - Street 1:73 RIDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-433-7039
Mailing Address - Fax:207-990-3844
Practice Address - Street 1:73 RIDGEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-990-0928
Practice Address - Fax:207-990-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20C0001007261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME902425OtherHARVARD PILGRIM
ME100342300OtherUS DEPT OF LABOR
ME201007001007OtherBLUE CROSS/BLUE SHIELD
ME490001551OtherRR MEDICARE PIN
ME5444660OtherAETNA
ME121350000Medicaid
ME201007001007OtherBLUE CROSS/BLUE SHIELD
ME201007001007OtherBLUE CROSS/BLUE SHIELD