Healthcare Provider Details

I. General information

NPI: 1396736377
Provider Name (Legal Business Name): TOWN OF EDGARTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 PEASE POINT WAY
EDGARTOWN MA
02539
US

IV. Provider business mailing address

9 MAIN ST STE 2K
SUTTON MA
01590-1660
US

V. Phone/Fax

Practice location:
  • Phone: 508-627-5167
  • Fax:
Mailing address:
  • Phone: 508-476-9740
  • Fax: 508-476-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateMA

VIII. Authorized Official

Name: PETER G SHEMETH
Title or Position: CHIEF
Credential:
Phone: 508-627-5167