Provider Demographics
NPI:1114079886
Name:LIFEFLIGHT OF MAINE, LLC
Entity type:Organization
Organization Name:LIFEFLIGHT OF MAINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-973-4702
Mailing Address - Street 1:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0796
Mailing Address - Country:US
Mailing Address - Phone:207-275-0294
Mailing Address - Fax:207-275-2977
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-275-2961
Practice Address - Fax:207-275-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMEMS 807 - 8083416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1315900Medicaid
MEAM0047Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER