Healthcare Provider Details

I. General information

NPI: 1265497937
Provider Name (Legal Business Name): TOWN OF POLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 MAINE ST
POLAND ME
04274-7328
US

IV. Provider business mailing address

PO BOX 1810
WINDHAM ME
04062
US

V. Phone/Fax

Practice location:
  • Phone: 207-998-4689
  • 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 Number543
License Number StateME

VIII. Authorized Official

Name: MARK BOSSE
Title or Position: CHIEF OF SERVICE
Credential:
Phone: 207-998-4689