Provider Demographics
NPI:1992789184
Name:KENNEBEC ANESTHESIA ASSOCIATES, P.A.
Entity type:Organization
Organization Name:KENNEBEC ANESTHESIA ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-620-1136
Mailing Address - Street 1:35 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:STE 201
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8160
Mailing Address - Country:US
Mailing Address - Phone:207-622-1959
Mailing Address - Fax:207-430-4007
Practice Address - Street 1:35 MEDICAL CENTER PARKWAY
Practice Address - Street 2:STE 201
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8160
Practice Address - Country:US
Practice Address - Phone:207-622-1959
Practice Address - Fax:207-430-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME105780000Medicaid
ME105780000Medicaid