Healthcare Provider Details

I. General information

NPI: 1588781777
Provider Name (Legal Business Name): BOOTHBAY REGION AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 COREY LANE
BOOTHBAY ME
04537
US

IV. Provider business mailing address

PO BOX 1810
WINDHAM ME
04062-1810
US

V. Phone/Fax

Practice location:
  • Phone: 207-633-7711
  • Fax: 207-633-4491
Mailing address:
  • Phone: 207-892-0020
  • Fax: 207-893-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0104
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number104
License Number StateME

VIII. Authorized Official

Name: SCOTT LASH
Title or Position: CHIEF
Credential:
Phone: 207-633-7711