Healthcare Provider Details

I. General information

NPI: 1588691778
Provider Name (Legal Business Name): FAIRFAX EMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GOODALL STREET
FAIRFAX VT
05454-0428
US

IV. Provider business mailing address

PO BOX 428
FAIRFAX VT
05454-0428
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-2023
  • Fax:
Mailing address:
  • Phone: 802-849-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0104
License Number StateVT

VIII. Authorized Official

Name: MR. DANIEL VANSLETTE
Title or Position: PRESIDENT
Credential:
Phone: 802-849-2773