Provider Demographics
NPI:1376763003
Name:TOWN OF SOUTH THOMASTON
Entity Type:Organization
Organization Name:TOWN OF SOUTH THOMASTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-964-9200
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:SOUTH THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04858-0147
Mailing Address - Country:US
Mailing Address - Phone:800-964-9200
Mailing Address - Fax:
Practice Address - Street 1:125 SPRUCE HEAD ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04858
Practice Address - Country:US
Practice Address - Phone:800-964-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME660341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME707449Medicare PIN