Healthcare Provider Details

I. General information

NPI: 1356410286
Provider Name (Legal Business Name): CAMBRIDGE RESCUE SQUAD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 WILLIAMSON COURT
JEFFERSONVILLE VT
05464
US

IV. Provider business mailing address

PO BOX 431
JEFFERSONVILLE VT
05464-0431
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-2113
  • Fax:
Mailing address:
  • Phone: 802-644-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0413
License Number StateVT

VIII. Authorized Official

Name: MR. DAVID BERNARD SEVERANCE
Title or Position: CHIEF
Credential:
Phone: 802-644-2113