Provider Demographics
NPI:1568596401
Name:MERIDIAN MOBILE HEALTH LLC
Entity Type:Organization
Organization Name:MERIDIAN MOBILE HEALTH LLC
Other - Org Name:CAPITAL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF GROUND TRANSPORT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-973-6700
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0940
Mailing Address - Country:US
Mailing Address - Phone:207-973-4700
Mailing Address - Fax:207-973-4713
Practice Address - Street 1:931 UNION STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-4700
Practice Address - Fax:207-973-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME130900000Medicaid
025094OtherANTHEM
ME130900000Medicaid