Provider Demographics
NPI:1043243579
Name:GOODWINS MILLS RESCUE
Entity Type:Organization
Organization Name:GOODWINS MILLS RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF EMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:DEPUTY CHIEF FF EMT
Authorized Official - Phone:207-499-2362
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062
Mailing Address - Country:US
Mailing Address - Phone:207-892-0020
Mailing Address - Fax:207-893-0583
Practice Address - Street 1:481 GOODWINS MILLS RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:ME
Practice Address - Zip Code:04002
Practice Address - Country:US
Practice Address - Phone:207-929-3167
Practice Address - Fax:207-467-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2973416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME024395OtherBLUE CROSS
ME703710Medicare ID - Type Unspecified