Healthcare Provider Details

I. General information

NPI: 1730199399
Provider Name (Legal Business Name): UPPER KENNEBEC VALLEY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MAIN ST
BINGHAM ME
04920-9999
US

IV. Provider business mailing address

PO BOX 1810
WINDHAM ME
04062-1810
US

V. Phone/Fax

Practice location:
  • Phone: 207-672-5519
  • Fax:
Mailing address:
  • Phone: 207-892-0020
  • Fax: 207-893-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number715
License Number StateME

VIII. Authorized Official

Name: MRS. LAURIE LAWERYSON
Title or Position: EMS COORDINATOR
Credential:
Phone: 207-672-4078