Healthcare Provider Details

I. General information

NPI: 1376763003
Provider Name (Legal Business Name): TOWN OF SOUTH THOMASTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SPRUCE HEAD ROAD
SOUTH THOMASTON ME
04858
US

IV. Provider business mailing address

PO BOX 147
SOUTH THOMASTON ME
04858-0147
US

V. Phone/Fax

Practice location:
  • Phone: 800-964-9200
  • Fax:
Mailing address:
  • Phone: 800-964-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number660
License Number StateME

VIII. Authorized Official

Name: RICHARD NORMAN
Title or Position: SERVICE CHIEF
Credential:
Phone: 800-964-9200