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General NPI Number Information
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NPI Number | 1114079886
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Entity Type | Organization
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Legal Business Name | LIFEFLIGHT OF MAINE, LLC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 489 STATE ST
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City | BANGOR
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State | ME
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Zip | 04401-6616
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Country | US
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Telephone | 207-275-2961
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Fax | 207-275-2977
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Provider Business Mailing Address
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Address Line | PO BOX 796
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City | BANGOR
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State | ME
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Zip | 04402-0796
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Country | US
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Telephone | 207-275-0294
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Fax | 207-275-2977
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JOSEPH CLARK KELLNER
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Credential |
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Telephone | 207-973-4702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number | MEMS 807 - 808
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License Number State | ME
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