NPIMap

Organization Active NPI

Kennebec Pharmacy and Home Care LLC

  • Oxygen Equipment & Supplies (DME)
  • Brunswick, ME
National Provider Identifier
1063445625
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
Legal business name
KENNEBEC PHARMACY AND HOME CARE LLC
Practice address
121 Medical Center Dr
Ste G500
Brunswick, ME 04011-2653
Phone
(207) 729-3642
Fax
(207) 729-2704
NPI assigned
Jul 8, 2006
Last updated
Sep 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ted Nathan Trebilcock
Title
Controller
Phone
(207) 626-2726

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Oxygen Equipment & Supplies (DME) 332BX2000X NU Primary

Addresses

Primary practice location

121 Medical Center Dr
Ste G500
Brunswick, ME 04011-2653

Mailing address

43 Leighton Rd
Augusta, ME 04330-7705
Phone (207) 626-2726

Other identifiers 2

IdentifierTypeStateIssuer
110020000MedicaidME
2000951OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130411000310 ME DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 7214057546 Practice locations: Brunswick, ME
O20151118000564 ME Part B Supplier - Mass Immunization (Roster Biller Only) 7214057546 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Augusta, ME; Rockport, ME; Brunswick, ME

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kennebec Pharmacy and Home Care LLC121 Medical Center Dr, Brunswick, ME 04011-2653(207) 729-3642 Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Gastric Suction Pumps|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|External Infusion Pumps and/or Supplies|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Canes and/or Crutches|Patient Lifts|P… Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Kennebec Pharmacy Home Car4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

121 Medical Center Dr
Ste G500
Brunswick, ME 04011
Phone (207) 373-6099

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1063445625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 LEIGHTON RD",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043307705",
            "telephone_number": "207-626-2726",
            "fax_number": "207-729-2704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 MEDICAL CENTER DR",
            "address_2": "STE G500",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112653",
            "telephone_number": "207-729-3642",
            "fax_number": "207-729-2704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEBEC PHARMACY AND HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "TREBILCOCK",
        "authorized_official_first_name": "TED",
        "authorized_official_middle_name": "NATHAN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "207-626-2726"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110020000",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2000951",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.