1336251529 NPI number — LOWER SOMERSET AMBULANCE AND RESCUE

Table of content: (NPI 1336251529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336251529 NPI number — LOWER SOMERSET AMBULANCE AND RESCUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWER SOMERSET AMBULANCE AND RESCUE
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:
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:
1336251529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRISFIELD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21817-0406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-968-2000
Provider Business Mailing Address Fax Number:
410-968-0416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MILL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRISFIELD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21817-0406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-968-2000
Provider Business Practice Location Address Fax Number:
410-968-0416
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RETTIG
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-968-2000

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y677 . This is a "CAREFIRST BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 840641300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com