Healthcare Provider Details

I. General information

NPI: 1780667600
Provider Name (Legal Business Name): TOWN OF KENNEBUNK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SUMMER ST
KENNEBUNK ME
04043-6641
US

IV. Provider business mailing address

PO BOX 1810
WINDHAM ME
04062-1810
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-2102
  • 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 Number0390
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier014819
Identifier TypeOTHER
Identifier State
Identifier IssuerANTHEM BLUE CROSS
# 2
Identifier590008496
Identifier TypeOTHER
Identifier State
Identifier IssuerRR MEDICARE
# 3
Identifier136750000
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name: JUSTIN COOPER
Title or Position: CHIEF
Credential:
Phone: 207-604-1358