MEDICARE: WHITE RIVER VALLEY AMBULANCE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	0804	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590092508	OTHER	VT	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	VT BLUE CROSS BLUE	OTHER	VT	6449

General Provider Information

NPI Number	:	1326115593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE RIVER VALLEY AMBULANCE, INC.

Provider Business Mailing Address
First Line	:	3190 PLEASANT STREET
Second Line	:
City	:	BETHEL
State	:	VT
Zip	:	05032
Country	:	US
Telephone Number	:	802-234-6800
Fax Number	:	802-234-6529

Provider Business Practice Location Address
First Line	:	3190 PLEASANT STREET
Second Line	:
City	:	BETHEL
State	:	VT
Zip	:	05032
Country	:	US
Telephone Number	:	802-234-6800
Fax Number	:	802-234-5629

Authorized Official
Title or Position	:	OPERATIONS SUPERVISOR
Name	:	PATRICIA A EDWARDS
Credential	:
Telephone Number	:	802-234-6800

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	11/14/2011

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Directions to “WHITE RIVER VALLEY AMBULANCE, INC. ” Practice Location

Language	Start Address	Practice Location

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