Healthcare Provider Details

I. General information

NPI: 1962493312
Provider Name (Legal Business Name): WATERBURY AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 GUPTIL RD
WATERBURY CENTER VT
05677-7094
US

IV. Provider business mailing address

PO BOX 95
WATERBURY CENTER VT
05677-0095
US

V. Phone/Fax

Practice location:
  • Phone: 802-244-5003
  • Fax: 802-244-4929
Mailing address:
  • Phone: 802-244-5003
  • Fax: 800-802-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0608
License Number StateVT

VIII. Authorized Official

Name: JOHN H KUEFFNER
Title or Position: VICE PRESIDENT
Credential: EMT-I
Phone: 802-244-5003