Basic Information
| Provider Information | |||||||||
| NPI: | 1841270642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEACOAST FOOT & ANKLE SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 810 | ||||||||
| Address2: | |||||||||
| City: | WESTBROOK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040980810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078541544 | ||||||||
| FaxNumber: | 2078541516 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 RTE 236 | ||||||||
| Address2: | STE 210 | ||||||||
| City: | KITTERY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 03904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074392101 | ||||||||
| FaxNumber: | 2074392199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | KURTZ | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2074392101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | POD1030 | ME | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 03Y002802ME02 | 01 | NH | ANTHEM NH | OTHER | 1841270642 | 01 | ME | GROUP NPI # | OTHER | MM8140 | 01 | ME | MEDICARE IND # | OTHER | 1851499768 | 01 | ME | IND NPI# | OTHER | 060678 | 01 | ME | ANTHEM | OTHER | 077629104 | 05 | ME | MEDICAID | 163540000 | 01 | ME | MAINECARE GROUP # | OTHER |