Provider Demographics
NPI:1043330947
Name:TOWN OF CLINTON
Entity Type:Organization
Organization Name:TOWN OF CLINTON
Other - Org Name:CLINTON AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-964-9200
Mailing Address - Street 1:27 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:ME
Mailing Address - Zip Code:04927-3551
Mailing Address - Country:US
Mailing Address - Phone:800-964-9200
Mailing Address - Fax:
Practice Address - Street 1:27 BAKER ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:ME
Practice Address - Zip Code:04927-3551
Practice Address - Country:US
Practice Address - Phone:800-964-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136360000Medicaid
ME706728Medicare ID - Type UnspecifiedMEDICARE