1326021155 NPI number — PETIT MANAN AMBULANCE CORPS INC.

Table of content: (NPI 1326021155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326021155 NPI number — PETIT MANAN AMBULANCE CORPS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETIT MANAN AMBULANCE CORPS INC.
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:
Provider Other Organization Name Type Code:
6
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:
1326021155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 188
Provider Second Line Business Mailing Address:
18 SCHOOL ST.
Provider Business Mailing Address City Name:
MILBRIDGE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-546-2254
Provider Business Mailing Address Fax Number:
207-546-2254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 SCHOOL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILBRIDGE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-546-2254
Provider Business Practice Location Address Fax Number:
207-546-2254
Provider Enumeration Date:
11/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PARRITT
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
DIRECTOR/SERVICE REP
Authorized Official Telephone Number:
207-546-7038

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  537 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 537 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 168160000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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