1407832819 NPI number — ALBURG VOLUNTEER FIRE DEPARTMENT, INC.

Table of content: (NPI 1407832819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407832819 NPI number — ALBURG VOLUNTEER FIRE DEPARTMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBURG VOLUNTEER FIRE DEPARTMENT, 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:
6
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:
1407832819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 FIREHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBURGH
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05440-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-796-3402
Provider Business Mailing Address Fax Number:
802-796-3162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 FIREHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBURG
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05440-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-338-7482
Provider Business Practice Location Address Fax Number:
802-796-3162
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOTSHALL
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
802-338-7482

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0101 , 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: ALBU29430 . This is a "BLUE CROSS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: OVN1520 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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