Provider Demographics
NPI:1578623625
Name:KENNEBEC MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:KENNEBEC MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BILODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:207-872-6869
Mailing Address - Street 1:13 RAILROAD SQ
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6139
Mailing Address - Country:US
Mailing Address - Phone:207-872-6869
Mailing Address - Fax:207-872-7910
Practice Address - Street 1:13 RAILROAD SQ
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6139
Practice Address - Country:US
Practice Address - Phone:207-872-6869
Practice Address - Fax:207-872-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care