Provider Demographics
NPI:1063437291
Name:TOWN OF SEARSPORT
Entity type:Organization
Organization Name:TOWN OF SEARSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TOWN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:GILLWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-548-6372
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-0499
Mailing Address - Country:US
Mailing Address - Phone:207-548-2302
Mailing Address - Fax:
Practice Address - Street 1:3 UNION ST
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974-3344
Practice Address - Country:US
Practice Address - Phone:207-548-6372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010988OtherANTHEM BLUE CROSS
ME137180000Medicaid
ME137180000Medicaid