Provider Demographics
NPI:1063607422
Name:ACADIA MEDICAL ARTS PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:ACADIA MEDICAL ARTS PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-990-0928
Mailing Address - Street 1:404 STATE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6652
Mailing Address - Country:US
Mailing Address - Phone:207-990-0928
Mailing Address - Fax:207-945-4354
Practice Address - Street 1:404 STATE ST STE 300
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6623
Practice Address - Country:US
Practice Address - Phone:207-990-0928
Practice Address - Fax:207-945-4354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA MEDICAL ARTS AMBULATORY SURGERY SUITES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7937210OtherCIGNA
ME1716688OtherAETNA
ME200363OtherBLUE CROSS/BLUE SHIELD
ME432748500Medicaid
ME0004000Medicare PIN