Healthcare Provider Details

I. General information

NPI: 1346363009
Provider Name (Legal Business Name): INDIAN TOWNSHIP TRIBAL GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 US ROUTE 1
PRINCETON ME
04668
US

IV. Provider business mailing address

PO BOX 97
PRINCETON ME
04668-0097
US

V. Phone/Fax

Practice location:
  • Phone: 207-796-2744
  • Fax: 207-942-8213
Mailing address:
  • Phone: 207-796-2744
  • Fax: 207-942-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number365
License Number StateME

VIII. Authorized Official

Name: ANDREA M HANSON
Title or Position: COMPLIANCE SPECIALISIT
Credential:
Phone: 207-796-2321