Healthcare Provider Details

I. General information

NPI: 1720062987
Provider Name (Legal Business Name): MEMORIAL AMBULANCE CORPS. ISLE AU HAUT - STONINGTON - DEER ISLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SUNSHINE RD
DEER ISLE ME
04627
US

IV. Provider business mailing address

P O BOX 387
DEER ISLE ME
04627
US

V. Phone/Fax

Practice location:
  • Phone: 207-348-5686
  • Fax: 207-348-5692
Mailing address:
  • Phone: 207-348-5686
  • Fax: 207-348-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number460
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number460
License Number StateME

VIII. Authorized Official

Name: WALTER T. REED
Title or Position: DIRECTOR - MEMORIAL AMBULANCE CORPS
Credential: EMT-I
Phone: 207-348-5686