Provider Demographics
NPI:1932218435
Name:TOWN OF VAN BUREN
Entity Type:Organization
Organization Name:TOWN OF VAN BUREN
Other - Org Name:VAN BUREN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-868-2886
Mailing Address - Street 1:51 MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-1027
Mailing Address - Country:US
Mailing Address - Phone:207-868-2886
Mailing Address - Fax:207-868-2222
Practice Address - Street 1:123 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1086
Practice Address - Country:US
Practice Address - Phone:207-868-3452
Practice Address - Fax:207-868-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME720341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
704547Medicare PIN