1982672119 NPI number — DELTA AMBULANCE CORP.

Table of content: (NPI 1982672119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982672119 NPI number — DELTA AMBULANCE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA AMBULANCE CORP.
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:
DELTA AMBULANCE
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:
1982672119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 CHASE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901-4642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-861-4239
Provider Business Mailing Address Fax Number:
207-861-4475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 CHASE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-4642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-861-4239
Provider Business Practice Location Address Fax Number:
207-861-4475
Provider Enumeration Date:
03/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEALS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
207-861-4225

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  215 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 106800000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".