Provider Demographics
NPI:1902068885
Name:TOWN OF DENNYSVILLE
Entity Type:Organization
Organization Name:TOWN OF DENNYSVILLE
Other - Org Name:DENNYSVILLE VOL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF VOLUNTEER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:207-726-4674
Mailing Address - Street 1:1935 US RTE 1
Mailing Address - Street 2:
Mailing Address - City:EDMUNDS TWP
Mailing Address - State:ME
Mailing Address - Zip Code:04628-5412
Mailing Address - Country:US
Mailing Address - Phone:207-726-4674
Mailing Address - Fax:
Practice Address - Street 1:58 KING STREET
Practice Address - Street 2:
Practice Address - City:DENNYSVILLE
Practice Address - State:ME
Practice Address - Zip Code:04628
Practice Address - Country:US
Practice Address - Phone:207-726-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME164500000Medicaid
ME164500000Medicaid
ME706787Medicare PIN