MEDICARE: MONMOUTH RESCUE ASSOCIATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	473	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590009753	OTHER	ME	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	007010	OTHER	ME	BLUE CROSS

General Provider Information

NPI Number	:	1013960673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONMOUTH RESCUE ASSOCIATION, INC

Provider Business Mailing Address
First Line	:	PO BOX 1810
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-1810
Country	:	US
Telephone Number	:	207-892-0020
Fax Number	:	207-893-0583

Provider Business Practice Location Address
First Line	:	847 MAIN ST
Second Line	:
City	:	MONMOUTH
State	:	ME
Zip	:	04259
Country	:	US
Telephone Number	:	207-933-2615
Fax Number	:	207-933-6458

Authorized Official
Title or Position	:	CHIEF OF SERVICE
Name	:	STEPHEN F HARRISON
Credential	:
Telephone Number	:	207-933-6727

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/15/2013

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