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General NPI Number Information
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NPI Number | 1134148331
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Entity Type | Organization
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Legal Business Name | CITY OF SOUTH PORTLAND
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 684 BROADWAY
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4407
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Country | US
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Telephone | 207-797-3314
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1810
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City | WINDHAM
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State | ME
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Zip | 04062-1810
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Country | US
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Telephone | 207-892-0020
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Fax | 207-893-0583
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Authorized Official
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Title or Position | EMS COORDINATOR
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Name | MR. MICHAEL E CARROLL
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Credential | EMT P
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Telephone | 207-799-3314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 655
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License Number State | ME
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