Provider Demographics
NPI:1376661389
Name:MOOSABEC AMBULANCE SERVICE
Entity Type:Organization
Organization Name:MOOSABEC AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/ BILLING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LENFESTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-497-2847
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:JONESPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04649-0164
Mailing Address - Country:US
Mailing Address - Phone:207-497-2847
Mailing Address - Fax:207-497-2847
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESPORT
Practice Address - State:ME
Practice Address - Zip Code:04649
Practice Address - Country:US
Practice Address - Phone:207-497-2847
Practice Address - Fax:207-497-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME385341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135460000Medicaid
041258OtherANTHEM
041258OtherANTHEM