=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225165129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF BELFAST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 09/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 273 MAIN STREET
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-338-3362
-----------------------------------------------------
Fax | 207-236-9679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1810
-----------------------------------------------------
City | WINDHAM
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04062-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-892-0020
-----------------------------------------------------
Fax | 207-893-0583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SERVICE CHIEF
-----------------------------------------------------
Name | JAMES RICHARDS
-----------------------------------------------------
Credential | EMTB
-----------------------------------------------------
Telephone | 207-338-3362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 085
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 0085
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------