Provider Demographics
NPI:1982695870
Name:CITY OF GLOUCESTER
Entity Type:Organization
Organization Name:CITY OF GLOUCESTER
Other - Org Name:CITY OF GLOUCESTER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDER
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-281-9760
Mailing Address - Street 1:8 SCHOOL ST.
Mailing Address - Street 2:CITY OF GLOUCESTER FIRE DEPARTMENT AMBULANCE SERVICE
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930
Mailing Address - Country:US
Mailing Address - Phone:978-281-9760
Mailing Address - Fax:978-281-9822
Practice Address - Street 1:8 SCHOOL ST.
Practice Address - Street 2:CITY OF GLOUCESTER FIRE DEPARTMENT AMBULANCE SERVICE
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-281-9760
Practice Address - Fax:978-281-9822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF GLOUCESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-31
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3206341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000025527OtherBMC HEALTHNET PLAN
MA1710257Medicaid
0009594OtherNEIGHBORHOOD HEALTH
103511900OtherUS DEPARTMENT OF LABOR
700851OtherHARVARD PILGRIM
801154OtherTUFTS HEALTH PLAN
590011167OtherRR MEDICARE
MA041659Medicare ID - Type Unspecified