Provider Demographics
NPI:1558399295
Name:NORTHEAST MOBILE HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTHEAST MOBILE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:207-510-0073
Mailing Address - Street 1:189 ODLIN RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6703
Mailing Address - Country:US
Mailing Address - Phone:207-510-0073
Mailing Address - Fax:207-885-5566
Practice Address - Street 1:24 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8311
Practice Address - Country:US
Practice Address - Phone:207-510-0073
Practice Address - Fax:207-883-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME488341600000X
ME487341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME130610000Medicaid
ME130610002Medicaid
ME130610004Medicaid
1558399295Medicare NSC