Provider Demographics
NPI:1093909699
Name:TOWN OF WARREN
Entity Type:Organization
Organization Name:TOWN OF WARREN
Other - Org Name:WARREN AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-354-2278
Mailing Address - Street 1:167 WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:ME
Mailing Address - Zip Code:04864-4279
Mailing Address - Country:US
Mailing Address - Phone:207-354-2278
Mailing Address - Fax:207-273-3373
Practice Address - Street 1:167 WESTERN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4279
Practice Address - Country:US
Practice Address - Phone:207-354-2278
Practice Address - Fax:207-273-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME733341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
006239OtherANTHEM
ME137390000Medicaid
ME708496Medicare PIN