Healthcare Provider Details

I. General information

NPI: 1437139243
Provider Name (Legal Business Name): SOUTHERN BERKSHIRE VOLUNTEER AMBULANCE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 LEWIS AVE
GREAT BARRINGTON MA
01230-1713
US

IV. Provider business mailing address

31 LEWIS AVE
GREAT BARRINGTON MA
01230-1713
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-3632
  • Fax:
Mailing address:
  • Phone: 413-528-3632
  • Fax: 413-528-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3365
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KEVIN WALL
Title or Position: CHIEF OF OPERATIONS
Credential:
Phone: 413-528-3632