1720062987 NPI number — MEMORIAL AMBULANCE CORPS. ISLE AU HAUT - STONINGTON - DEER ISLE

Table of content: (NPI 1720062987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720062987 NPI number — MEMORIAL AMBULANCE CORPS. ISLE AU HAUT - STONINGTON - DEER ISLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL AMBULANCE CORPS. ISLE AU HAUT - STONINGTON - DEER ISLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEMORIAL AMBULANCE CORPS.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720062987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEER ISLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-348-5686
Provider Business Mailing Address Fax Number:
207-348-5692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 SUNSHINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER ISLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-348-5686
Provider Business Practice Location Address Fax Number:
207-348-5692
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
DIRECTOR - MEMORIAL AMBULANCE CORPS
Authorized Official Telephone Number:
207-348-5686

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  460 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 460 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104070000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com