MEDICARE: PASSAMAQUODDY TRIBAL COUNCIL

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	640	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	:	1902967060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSAMAQUODDY TRIBAL COUNCIL

Provider Business Mailing Address
First Line	:	PO BOX 351
Second Line	:
City	:	PERRY
State	:	ME
Zip	:	04667-0351
Country	:	US
Telephone Number	:	207-853-0644
Fax Number	:	207-853-2347

Provider Business Practice Location Address
First Line	:	11 BACK ROAD
Second Line	:
City	:	PERRY
State	:	ME
Zip	:	04667-0351
Country	:	US
Telephone Number	:	207-853-0644
Fax Number	:	207-853-2347

Authorized Official
Title or Position	:	HEALTH DIRECTOR
Name	:	ELIZABETH NEPTUNE
Credential	:
Telephone Number	:	207-853-0644

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/05/2021

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Directions to “PASSAMAQUODDY TRIBAL COUNCIL ” Practice Location

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