1962493312 NPI number — WATERBURY AMBULANCE SERVICE, INC.

Table of content: (NPI 1962493312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962493312 NPI number — WATERBURY AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATERBURY AMBULANCE 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:
1962493312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERBURY CENTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05677-0095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-244-5003
Provider Business Mailing Address Fax Number:
800-802-6803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1727 GUPTIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY CENTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05677-7094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-244-5003
Provider Business Practice Location Address Fax Number:
802-244-4929
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KUEFFNER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
802-244-5003

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0608 , 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: 0006444 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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