Healthcare Provider Details

I. General information

NPI: 1629099585
Provider Name (Legal Business Name): TOWN OF WATERBORO MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 JOHN SMITH RD
WATERBORO ME
04087
US

IV. Provider business mailing address

PO BOX 1810
WINDHAM ME
04062
US

V. Phone/Fax

Practice location:
  • Phone: 207-247-5299
  • 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 Number735
License Number StateME

VIII. Authorized Official

Name: NANCY J BRANDT
Title or Position: TOWN ADMINISTRATOR
Credential:
Phone: 207-247-6166