1932219961 NPI number — SOUTHWESTERN VERMONT REGIONAL AMBULANCE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932219961 NPI number — SOUTHWESTERN VERMONT REGIONAL AMBULANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN VERMONT REGIONAL AMBULANCE, 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:
1932219961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05201-0911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-447-0413
Provider Business Mailing Address Fax Number:
802-447-0417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 MORSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-1662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-447-0413
Provider Business Practice Location Address Fax Number:
802-447-0417
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRECHETTE
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
802-447-0413

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1213 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1005052 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 70808 . This is a "MOHAWK VALLEY PROVIDER #" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 10025293 . This is a "CAPITAL DISTRICT PHYS HEA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 28118 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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