Provider Demographics
NPI:1952478737
Name:TOWN OF MADAWASKA
Entity Type:Organization
Organization Name:TOWN OF MADAWASKA
Other - Org Name:MADAWASKA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TOWN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-728-6351
Mailing Address - Street 1:PO BOX 1820
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-1820
Mailing Address - Country:US
Mailing Address - Phone:207-764-7529
Mailing Address - Fax:207-764-6504
Practice Address - Street 1:428 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1105
Practice Address - Country:US
Practice Address - Phone:207-728-6126
Practice Address - Fax:207-728-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME437146L00000X
341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME007776OtherANTHEM PROVIDER ID
ME136820000Medicaid
ME=========OtherANTHEM GROUP #