Provider Demographics
NPI:1013023027
Name:INDEPENDENT MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:207-947-0768
Mailing Address - Street 1:78 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2652
Mailing Address - Country:US
Mailing Address - Phone:207-947-0768
Mailing Address - Fax:207-945-9705
Practice Address - Street 1:78 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2652
Practice Address - Country:US
Practice Address - Phone:207-947-0768
Practice Address - Fax:207-945-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM0811Medicare ID - Type Unspecified