MEDICARE: SOUTHERN BERKSHIRE VOLUNTEER AMBULANCE SQUAD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	3365	MA
2	3416L0300X	Land Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	441590232	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700865	OTHER		HARVARD PILGRIM
2	744846	OTHER		CONNECTICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000022136	OTHER		BMC HEALTHNET PLAN
6	610068600	OTHER		DEPARTMENT OF LABOR
7	805052	OTHER		TUFTS HEALTH
8	0017302	OTHER		NEIGHBORHOOD HEALTH
9	030659	OTHER	MA	BLUE CROSS BLUE SHIELD
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	937093	OTHER		MVP HEALTH CARE

General Provider Information

NPI Number	:	1437139243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN BERKSHIRE VOLUNTEER AMBULANCE SQUAD INC

Provider Business Mailing Address
First Line	:	31 LEWIS AVE
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1713
Country	:	US
Telephone Number	:	413-528-3632
Fax Number	:	413-528-5549

Provider Business Practice Location Address
First Line	:	31 LEWIS AVE
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1713
Country	:	US
Telephone Number	:	413-528-3632
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OF OPERATIONS
Name	:	KEVIN WALL
Credential	:
Telephone Number	:	413-528-3632

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	12/07/2023

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