Healthcare Provider Details

I. General information

NPI: 1669125613
Provider Name (Legal Business Name): TOWN OF LIBERTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 W MAIN ST
LIBERTY ME
04949-0494
US

IV. Provider business mailing address

PO BOX 174
LIBERTY ME
04949-0174
US

V. Phone/Fax

Practice location:
  • Phone: 207-382-8260
  • Fax:
Mailing address:
  • Phone: 207-382-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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