Provider Demographics
NPI:1902967060
Name:PASSAMAQUODDY TRIBAL COUNCIL
Entity Type:Organization
Organization Name:PASSAMAQUODDY TRIBAL COUNCIL
Other - Org Name:SIPAYIK AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NEPTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-853-0644
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:ME
Mailing Address - Zip Code:04667-0351
Mailing Address - Country:US
Mailing Address - Phone:207-853-0644
Mailing Address - Fax:207-853-2347
Practice Address - Street 1:11 BACK ROAD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:ME
Practice Address - Zip Code:04667-0351
Practice Address - Country:US
Practice Address - Phone:207-853-0644
Practice Address - Fax:207-853-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107300000Medicaid
ME107300000Medicaid