MEDICARE: TOWN OF WELLFLEET OFFICE OF THE TREASURER

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

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
2	040559	OTHER	MA	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1578519666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF WELLFLEET OFFICE OF THE TREASURER

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

Provider Business Practice Location Address
First Line	:	35 LAWRENCE RD
Second Line	:
City	:	WELLFLEET
State	:	MA
Zip	:	02667-7703
Country	:	US
Telephone Number	:	508-349-3754
Fax Number	:	508-349-0318

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	RICHARD J. PAULEY JR.
Credential	:
Telephone Number	:	508-349-3754

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/24/2013

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