=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427513720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF SULLIVAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2019
-----------------------------------------------------
Last Update Date | 01/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1888 US HWY 1
-----------------------------------------------------
City | SULLIVAN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04664-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-422-6282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1888 US HWY 1
-----------------------------------------------------
City | SULLIVAN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04664-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-422-6282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASST. EMS CHIEF
-----------------------------------------------------
Name | JEREMY OGDEN
-----------------------------------------------------
Credential | NRAEMT
-----------------------------------------------------
Telephone | 207-422-3220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------