Healthcare Provider Details

I. General information

NPI: 1417903345
Provider Name (Legal Business Name): LOWER CAPE AMBULANCE ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 RACE POINT RD
PROVINCETOWN MA
02657-1528
US

IV. Provider business mailing address

PO BOX 161
WHITINSVILLE MA
01588-0161
US

V. Phone/Fax

Practice location:
  • Phone: 508-487-1733
  • Fax: 508-487-2287
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 State

VIII. Authorized Official

Name: STEVEN E RODERICK
Title or Position: TREASURER
Credential:
Phone: 508-487-1733