Healthcare Provider Details

I. General information

NPI: 1043430754
Provider Name (Legal Business Name): LIBERTY VOLUNTEER AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/11/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 W MAIN STREET
LIBERTY ME
04949-3401
US

IV. Provider business mailing address

PO BOX 174 187 W MAIN STREET
LIBERTY ME
04949-0174
US

V. Phone/Fax

Practice location:
  • Phone: 207-382-8260
  • Fax:
Mailing address:
  • Phone: 800-488-4351
  • Fax: 978-356-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number415
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: EARLE ALBERT
Title or Position: DEPUTY CHIEF
Credential:
Phone: 207-382-8260