1932219961 NPI number — SOUTHWESTERN VERMONT REGIONAL AMBULANCE, INC.

Table of content: (NPI 1932219961)

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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