Provider Demographics
NPI:1982837175
Name:MERMAID TRANSPORTATION
Entity Type:Organization
Organization Name:MERMAID TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-885-5630
Mailing Address - Street 1:PO BOX 10696
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-6096
Mailing Address - Country:US
Mailing Address - Phone:207-885-5630
Mailing Address - Fax:207-885-5631
Practice Address - Street 1:3 GLASGOW RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8781
Practice Address - Country:US
Practice Address - Phone:207-885-5630
Practice Address - Fax:207-885-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH433741800Medicaid