# NORTHERN LIGHT MEDICAL TRANSPORT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174017941
- **Authorized official:** MR. JOSEPH CLARK KELLNER (VP EMER SERVICES AND COMM PROGS)
- **Authorized official phone:** (207) 973-4702

## Contact information

- **Practice address:** 931 UNION ST, BANGOR, ME 04401-3011
- **Practice address phone:** (207) 973-4700
- **Practice address fax:** (207) 973-4713
- **Mailing address:** 43 WHITING HILL RD, BREWER, ME 04412-1005
- **Mailing address phone:** (207) 973-4702
- **Mailing address fax:** (207) 973-4713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 06/15/2018
- **Last updated:** 06/15/2018