# CITY OF SOUTH PORTLAND

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Portland Fire & Rescue
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134148331
- **Authorized official:** MR. MICHAEL E CARROLL EMT P (EMS COORDINATOR)
- **Authorized official phone:** (207) 799-3314

## Contact information

- **Practice address:** 684 BROADWAY, SOUTH PORTLAND, ME 04106-4407
- **Practice address phone:** (207) 797-3314
- **Mailing address:** PO BOX 1810, WINDHAM, ME 04062-1810
- **Mailing address phone:** (207) 892-0020
- **Mailing address fax:** (207) 893-0583

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 655 | ME | Yes |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 10/05/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001173 | BLUE CROSS | ME |
| 05 | — | 136070000 | — | ME |
| 01 | — | 590000162 | RAILROAD MEDICARE | ME |