Provider Demographics
NPI:1871709535
Name:TOWN OF FREEPORT
Entity type:Organization
Organization Name:TOWN OF FREEPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:207-865-3421
Mailing Address - Street 1:4 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1113
Mailing Address - Country:US
Mailing Address - Phone:207-865-3421
Mailing Address - Fax:207-865-2858
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1113
Practice Address - Country:US
Practice Address - Phone:207-865-3421
Practice Address - Fax:207-865-2858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF FREEPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
ME2703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590012201OtherRR MEDICARE
ME136550100Medicaid
ME136550100Medicaid