Provider Demographics
NPI:1821386343
Name:KENNEBEC MEDICAL CONSULTANTS
Entity Type:Organization
Organization Name:KENNEBEC MEDICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HURDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-877-9562
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0805
Mailing Address - Country:US
Mailing Address - Phone:207-877-9562
Mailing Address - Fax:207-877-9560
Practice Address - Street 1:13 RAILROAD SQ
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6139
Practice Address - Country:US
Practice Address - Phone:207-877-9562
Practice Address - Fax:207-877-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2163207Q00000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty