MEDICARE: TOWN OF EASTHAM

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	3095	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053304733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF EASTHAM

Provider Business Mailing Address
First Line	:	2520 STATE HWY
Second Line	:
City	:	EASTHAM
State	:	MA
Zip	:	02642-2544
Country	:	US
Telephone Number	:	508-255-2324
Fax Number	:	508-240-5932

Provider Business Practice Location Address
First Line	:	9 MAIN ST STE 2K
Second Line	:
City	:	SUTTON
State	:	MA
Zip	:	01590-1660
Country	:	US
Telephone Number	:	508-476-9740
Fax Number	:	508-476-9748

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. GLENN J. OLSON
Credential	:
Telephone Number	:	508-255-2324

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	03/01/2011

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