=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114090586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 04/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 HIGH ST
-----------------------------------------------------
City | ELLSWORTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-667-7224
-----------------------------------------------------
Fax | 207-667-7668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 724 208 HIGH ST
-----------------------------------------------------
City | ELLSWORTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04605-0724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-667-7224
-----------------------------------------------------
Fax | 207-667-7668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. JOHN F. PARTRIDGE SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-667-7224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 172
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------