Provider Demographics
NPI:1942266085
Name:KENNEBUNKPORT EMERGENCY MEDICAL SER INCORPORATED
Entity Type:Organization
Organization Name:KENNEBUNKPORT EMERGENCY MEDICAL SER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-892-0020
Mailing Address - Street 1:P O 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 1:172 MAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNKPORT
Practice Address - State:ME
Practice Address - Zip Code:04046-6911
Practice Address - Country:US
Practice Address - Phone:207-967-9704
Practice Address - Fax:207-967-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEVIN94187 VEHICLE 9873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109920000Medicaid
ME702475Medicare ID - Type Unspecified