Provider Demographics
NPI:1992731657
Name:CENTRAL LINCOLN COUNTY AMBULANCE
Entity type:Organization
Organization Name:CENTRAL LINCOLN COUNTY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-563-7105
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-0373
Mailing Address - Country:US
Mailing Address - Phone:207-563-8618
Mailing Address - Fax:207-563-8625
Practice Address - Street 1:29 PIPER MILL RD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4706
Practice Address - Country:US
Practice Address - Phone:207-563-8618
Practice Address - Fax:207-563-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME165740000Medicaid
ME71Z011784ME01OtherBCBS PROVIDER NUMBER
ME165740000Medicaid