Provider Demographics
NPI:1144451535
Name:ACADIA MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:ACADIA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-8876
Mailing Address - Street 1:104 BANGOR ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1662
Mailing Address - Country:US
Mailing Address - Phone:207-532-7100
Mailing Address - Fax:207-532-7200
Practice Address - Street 1:104 BANGOR ST STE B
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1662
Practice Address - Country:US
Practice Address - Phone:207-532-7100
Practice Address - Fax:207-532-7200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA MEDICAL SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-03
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1099966332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134980000Medicaid
ME=========1Medicare NSC