Provider Demographics
NPI:1912969023
Name:UNITED AMBULANCE
Entity Type:Organization
Organization Name:UNITED AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOSSELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-777-6006
Mailing Address - Street 1:192 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5435
Mailing Address - Country:US
Mailing Address - Phone:207-777-6010
Mailing Address - Fax:
Practice Address - Street 1:192 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5435
Practice Address - Country:US
Practice Address - Phone:207-777-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME702341600000X
ME703341600000X
ME343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99909039Medicaid
ME042892OtherBLUE CROSS
ME=========OtherCOMMERICAL
NH99909039Medicaid
P00051158Medicare ID - Type UnspecifiedRR MEDICAID