Provider Demographics
NPI:1891732210
Name:TOWN OF WAREHAM
Entity type:Organization
Organization Name:TOWN OF WAREHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-295-6725
Mailing Address - Street 1:9 MAIN ST
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-1660
Mailing Address - Country:US
Mailing Address - Phone:508-476-9740
Mailing Address - Fax:508-476-9748
Practice Address - Street 1:72 SANDWICH RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1629
Practice Address - Country:US
Practice Address - Phone:508-295-6725
Practice Address - Fax:508-291-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1707612Medicaid
MA034559OtherBCBS PROVIDER NUMBER
MA1707612Medicaid