Provider Demographics
NPI:1841270642
Name:SEACOAST FOOT & ANKLE SPECIALISTS
Entity type:Organization
Organization Name:SEACOAST FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-439-2101
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-0810
Mailing Address - Country:US
Mailing Address - Phone:207-854-1544
Mailing Address - Fax:207-854-1516
Practice Address - Street 1:37 RTE 236
Practice Address - Street 2:STE 210
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-439-2101
Practice Address - Fax:207-439-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1030213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH03Y002802ME02OtherANTHEM NH
ME1841270642OtherGROUP NPI #
MEMM8140OtherMEDICARE IND #
ME1851499768OtherIND NPI#
ME060678OtherANTHEM
ME077629104Medicaid
ME163540000OtherMAINECARE GROUP #
ME163540000OtherMAINECARE GROUP #
ME4973840001Medicare NSC