=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932219961
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWESTERN VERMONT REGIONAL AMBULANCE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 MORSE RD
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05201-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-447-0413
-----------------------------------------------------
Fax | 802-447-0417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 911
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05201-0911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-447-0413
-----------------------------------------------------
Fax | 802-447-0417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ANITA FRECHETTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-447-0413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1213
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------