1528056991 NPI number — CHARLESTOWN AMBULANCE & RESCUE SERVICE, INC.

Table of content: (NPI 1528056991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528056991 NPI number — CHARLESTOWN AMBULANCE & RESCUE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLESTOWN AMBULANCE & RESCUE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528056991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02813-0346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-364-3742
Provider Business Mailing Address Fax Number:
401-364-5438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4891 OLD POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02813-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-364-3742
Provider Business Practice Location Address Fax Number:
401-364-5438
Provider Enumeration Date:
10/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KETTLE
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
401-364-3742

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  10 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9009951 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590007904 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".