=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396736377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF EDGARTOWN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 07/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68 PEASE POINT WAY
-----------------------------------------------------
City | EDGARTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-627-5167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 MAIN ST STE 2K
-----------------------------------------------------
City | SUTTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01590-1660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-476-9740
-----------------------------------------------------
Fax | 508-476-9748
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | PETER G SHEMETH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-627-5167
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------