Provider Demographics
NPI:1326021155
Name:PETIT MANAN AMBULANCE CORPS INC.
Entity Type:Organization
Organization Name:PETIT MANAN AMBULANCE CORPS INC.
Other - Org Name:PETIT MANAN AMBULANCE CORPS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR/SERVICE REP
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARRITT
Authorized Official - Suffix:
Authorized Official - Credentials:EMTI
Authorized Official - Phone:207-546-7038
Mailing Address - Street 1:P.O. BOX 188
Mailing Address - Street 2:18 SCHOOL ST.
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658
Mailing Address - Country:US
Mailing Address - Phone:207-546-2254
Mailing Address - Fax:207-546-2254
Practice Address - Street 1:18 SCHOOL ST.
Practice Address - Street 2:
Practice Address - City:MILBRIDGE
Practice Address - State:ME
Practice Address - Zip Code:04658
Practice Address - Country:US
Practice Address - Phone:207-546-2254
Practice Address - Fax:207-546-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME537341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME168160000Medicaid
ME708380Medicare ID - Type UnspecifiedAMBULANCE SERVICE