Provider Demographics
NPI:1639643125
Name:ORRS AND BAILEY ISLANDS FIRE DEPARTMENT
Entity Type:Organization
Organization Name:ORRS AND BAILEY ISLANDS FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:207-833-5405
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-1810
Mailing Address - Country:US
Mailing Address - Phone:207-892-0020
Mailing Address - Fax:
Practice Address - Street 1:1600 HARPSWELL ISLAND RD
Practice Address - Street 2:
Practice Address - City:ORR'S ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04066
Practice Address - Country:US
Practice Address - Phone:207-833-5405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0510Medicaid