Provider Demographics
NPI:1053304733
Name:TOWN OF EASTHAM
Entity Type:Organization
Organization Name:TOWN OF EASTHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-255-2324
Mailing Address - Street 1:2520 STATE HWY
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-2544
Mailing Address - Country:US
Mailing Address - Phone:508-255-2324
Mailing Address - Fax:508-240-5932
Practice Address - Street 1:9 MAIN ST STE 2K
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-1660
Practice Address - Country:US
Practice Address - Phone:508-476-9740
Practice Address - Fax:508-476-9748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF EASTHAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-26
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1715925Medicaid
MA037359Medicare ID - Type UnspecifiedAMBULANCE