Provider Demographics
NPI:1356351910
Name:TOWN OF SEBAGO
Entity type:Organization
Organization Name:TOWN OF SEBAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESCUE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-787-4120
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-1810
Mailing Address - Country:US
Mailing Address - Phone:207-892-0020
Mailing Address - Fax:207-893-0583
Practice Address - Street 1:7 PIT ROAD
Practice Address - Street 2:
Practice Address - City:SEBAGO
Practice Address - State:ME
Practice Address - Zip Code:04029-9999
Practice Address - Country:US
Practice Address - Phone:207-787-4120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME024996OtherBLUE CROSS
ME154700000Medicaid
ME154700000Medicaid