Healthcare Provider Details

I. General information

NPI: 1730125709
Provider Name (Legal Business Name): NORTHEAST MOBILE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 1ST ST
TOPSHAM ME
04086-1334
US

IV. Provider business mailing address

189 ODLIN RD
BANGOR ME
04401-6703
US

V. Phone/Fax

Practice location:
  • Phone: 207-721-9772
  • Fax: 207-883-5566
Mailing address:
  • Phone: 207-510-0073
  • Fax: 207-885-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number486
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0488
License Number StateME

VIII. Authorized Official

Name: ROBERT E. RUSSELL III
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 207-510-0073