MEDICARE: CITY OF SANFORD

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	341600000X	Ambulance
2	3416L0300X	Land Ambulance	610	ME

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	:	1285639393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF SANFORD

Provider Business Mailing Address
First Line	:	972 MAIN ST
Second Line	:
City	:	SANFORD
State	:	ME
Zip	:	04073-3509
Country	:	US
Telephone Number	:	207-324-9160
Fax Number	:	207-324-5672

Provider Business Practice Location Address
First Line	:	972 MAIN ST
Second Line	:
City	:	SANFORD
State	:	ME
Zip	:	04073-3509
Country	:	US
Telephone Number	:	207-324-9160
Fax Number	:	207-324-5672

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	STEVE BENOTTI
Credential	:
Telephone Number	:	207-324-9160

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	02/24/2020

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Directions to “CITY OF SANFORD ” Practice Location

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