Healthcare Provider Details

I. General information

NPI: 1508366519
Provider Name (Legal Business Name): UNITED AMBULANCE BRIDGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HOSPITAL DR
BRIDGTON ME
04009-1166
US

IV. Provider business mailing address

192 RUSSELL ST
LEWISTON ME
04240-5435
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-6006
  • Fax: 207-777-6010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number702
License Number StateME

VIII. Authorized Official

Name: PAUL GOSSELIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-777-6006