Provider Demographics
NPI:1023133253
Name:PENINSULA AMBULANCE CORPS
Entity type:Organization
Organization Name:PENINSULA AMBULANCE CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:207-374-9955
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-0834
Mailing Address - Country:US
Mailing Address - Phone:207-374-9955
Mailing Address - Fax:207-374-5825
Practice Address - Street 1:42 WATER STREET
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-9955
Practice Address - Fax:207-374-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME138000000Medicaid
ME138000000Medicaid