Provider Demographics
NPI:1548090145
Name:TOWN OF ROCKPORT
Entity type:Organization
Organization Name:TOWN OF ROCKPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONNEVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-382-8555
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5963
Mailing Address - Country:US
Mailing Address - Phone:207-236-4437
Mailing Address - Fax:
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5962
Practice Address - Country:US
Practice Address - Phone:207-237-4437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty