Provider Demographics
NPI:1467666230
Name:UNIVERSITY OF MAINE
Entity Type:Organization
Organization Name:UNIVERSITY OF MAINE
Other - Org Name:UNIVERSITY OF VOLUNTEER AMBULANCE CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUXILIARY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-581-4184
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062
Mailing Address - Country:US
Mailing Address - Phone:207-892-0020
Mailing Address - Fax:207-893-0583
Practice Address - Street 1:5721 CUTLER HEALTH CENTER
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469
Practice Address - Country:US
Practice Address - Phone:207-281-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
ME07103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433823100Medicaid