Provider Demographics
NPI:1275523417
Name:TOWN OF SOUTHAMPTON
Entity Type:Organization
Organization Name:TOWN OF SOUTHAMPTON
Other - Org Name:SOUTHAMPTON AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LABRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-527-4254
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-0074
Mailing Address - Country:US
Mailing Address - Phone:413-527-4254
Mailing Address - Fax:413-527-4254
Practice Address - Street 1:200 COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9652
Practice Address - Country:US
Practice Address - Phone:413-527-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3380341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1711148Medicaid
MA1711148Medicaid