Provider Demographics
NPI:1134185648
Name:CITY OF PORTLAND
Entity type:Organization
Organization Name:CITY OF PORTLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-874-8409
Mailing Address - Street 1:PO BOX 16020
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-9597
Mailing Address - Country:US
Mailing Address - Phone:207-874-8400
Mailing Address - Fax:207-874-8410
Practice Address - Street 1:380 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3513
Practice Address - Country:US
Practice Address - Phone:207-874-8400
Practice Address - Fax:207-874-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5463416L0300X
ME05463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136040100Medicaid
ME1001171OtherBLUE CROSS
ME441590199OtherRAILROAD MEDICARE
ME441590199OtherRAILROAD MEDICARE