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Organization
CITY OF PORTLAND
Active
Organization
CITY OF PORTLAND
Active
Other names
City of Portland Medcu
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER H GOODALL (ASSISTANT FIRE CHIEF)
(207) 874-8409
Entity
Organization
Contact information
Practice address
380 CONGRESS ST, PORTLAND, ME 04101-3513
(207) 874-8400
(207) 874-8410
Mailing address
PO BOX 16020, LEWISTON, ME 04243-9597
(207) 874-8400
(207) 874-8410
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0546
ME
3416L0300X
Land Ambulance
546
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001171
BLUE CROSS
ME
05
—
136040100
—
ME
01
—
441590199
RAILROAD MEDICARE
ME
Enumeration date
04/24/2006
Last updated
04/27/2019
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