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General NPI Number Information
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NPI Number | 1588781777
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Entity Type | Organization
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Legal Business Name | BOOTHBAY REGION AMBULANCE SERVICE
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 18 COREY LANE
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City | BOOTHBAY
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State | ME
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Zip | 04537
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Country | US
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Telephone | 207-633-7711
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Fax | 207-633-4491
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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 | CHIEF
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Name | SCOTT LASH
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Credential |
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Telephone | 207-633-7711
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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 | 104
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 0104
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License Number State | ME
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