Provider Demographics
NPI:1841476561
Name:ACADIA MEDICAL CENTER, PA
Entity type:Organization
Organization Name:ACADIA MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEN-AIME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-621-8080
Mailing Address - Street 1:19503 NW 57TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4709
Mailing Address - Country:US
Mailing Address - Phone:305-621-8080
Mailing Address - Fax:305-624-2671
Practice Address - Street 1:19503 NW 57TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4709
Practice Address - Country:US
Practice Address - Phone:305-621-8080
Practice Address - Fax:305-624-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0056597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2686Medicare PIN