Provider Demographics
NPI:1912077405
Name:TOWN OF CUMBERLAND
Entity Type:Organization
Organization Name:TOWN OF CUMBERLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-829-5421
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-1810
Mailing Address - Country:US
Mailing Address - Phone:207-892-0020
Mailing Address - Fax:207-893-0583
Practice Address - Street 1:366 TUTTLE RD
Practice Address - Street 2:EMS BILLING
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-3627
Practice Address - Country:US
Practice Address - Phone:207-829-4085
Practice Address - Fax:207-829-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136410000Medicaid
ME702480Medicare PIN