MEDICARE: STONEHAM RESCUE 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	0678	ME

General Provider Information

NPI Number	:	1619235686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEHAM RESCUE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 1810
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-1810
Country	:	US
Telephone Number	:	207-892-0020
Fax Number	:	207-893-0583

Provider Business Practice Location Address
First Line	:	8 BUTTER HILL ROAD
Second Line	:
City	:	STONEHAM
State	:	ME
Zip	:	04231-0000
Country	:	US
Telephone Number	:	207-890-7481
Fax Number	:

Authorized Official
Title or Position	:	RESCUE CHIEF
Name	:	MR. FRED COFFIN
Credential	:
Telephone Number	:	207-890-7481

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	05/03/2012

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Directions to “STONEHAM RESCUE SERVICE ” Practice Location

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