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General NPI Number Information
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NPI Number | 1023189925
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Entity Type | Organization
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Legal Business Name | MAD RIVER VALLEY AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 4177 MAIN ST
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City | WAITSFIELD
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State | VT
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Zip | 05673-6095
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Country | US
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Telephone | 802-496-8888
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Fax | 802-329-2142
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | WAITSFIELD
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State | VT
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Zip | 05673-0305
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Country | US
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Telephone | 802-496-8888
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Fax | 802-329-2142
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Authorized Official
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Title or Position | CLAIMS ADMINISTRATOR
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Name | ROBIN M KINSELLA
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Credential |
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Telephone | 802-496-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | VT6442
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License Number State | VT
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