MEDICARE: TOWN OF WALDOBORO

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	341600000X	Ambulance	730	ME
2	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001187	OTHER	ME	ANTHEM BC/BS STAR NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053322792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF WALDOBORO

Provider Business Mailing Address
First Line	:	PO BOX J
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-0911
Country	:	US
Telephone Number	:	207-832-2160
Fax Number	:	207-832-2166

Provider Business Practice Location Address
First Line	:	1600 ATLANTIC HIGHWAY
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-6018
Country	:	US
Telephone Number	:	207-832-2160
Fax Number	:	207-832-6061

Authorized Official
Title or Position	:	SERVICE CHIEF
Name	:	DEREK S BOOKER
Credential	:	NRP
Telephone Number	:	207-832-2160

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/24/2024

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Directions to “TOWN OF WALDOBORO ” Practice Location

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