Provider Demographics
NPI:1679516462
Name:TOWN OF ROCKPORT
Entity Type:Organization
Organization Name:TOWN OF ROCKPORT
Other - Org Name:ROCKPORT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DEPARTMENT HEAD
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-479-3487
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:978-356-2721
Practice Address - Street 1:37 BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-1538
Practice Address - Country:US
Practice Address - Phone:978-479-3487
Practice Address - Fax:978-546-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
MA32053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1701304Medicaid
MA800516OtherTUFTS HEALTH PLAN
MA012859OtherBLUE CROSS & BLUE SHIELD
MA800516OtherTUFTS HEALTH PLAN