Provider Demographics
NPI:1407830938
Name:PENINSULA AMBULANCE CORPS, INC
Entity type:Organization
Organization Name:PENINSULA AMBULANCE CORPS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING CLERK
Authorized Official - Phone:207-359-8387
Mailing Address - Street 1:WATER STREET
Mailing Address - Street 2:P O BOX 834
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614
Mailing Address - Country:US
Mailing Address - Phone:207-374-9955
Mailing Address - Fax:207-359-0911
Practice Address - Street 1:80 WATER STREET
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:05614
Practice Address - Country:US
Practice Address - Phone:207-374-9955
Practice Address - Fax:207-359-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========OtherTAX ID NUMBER
ME704695Medicare ID - Type UnspecifiedPROVIDER NUMBER