MEDICARE: THREE RIVERS AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	685	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011545	OTHER	ME	ANTHEM BCBS

General Provider Information

NPI Number	:	1013057033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE RIVERS AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	25 W MAIN ST
Second Line	:	PO BOX 432
City	:	MILO
State	:	ME
Zip	:	04463-1016
Country	:	US
Telephone Number	:	207-943-2950
Fax Number	:	207-943-2950

Provider Business Practice Location Address
First Line	:	25 W MAIN ST
Second Line	:
City	:	MILO
State	:	ME
Zip	:	04463-1016
Country	:	US
Telephone Number	:	207-943-2950
Fax Number	:	207-943-2950

Authorized Official
Title or Position	:	CHAIRMAN, BOARD OF DIRECTORS
Name	:	MR. TODD LYFORD
Credential	:
Telephone Number	:	207-943-2950

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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Directions to “THREE RIVERS AMBULANCE SERVICE ” Practice Location

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