MEDICARE: POULTNEY RESCUE 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	1009	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590008698	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619967171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POULTNEY RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	PO BOX 290184
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06129-0184
Country	:	US
Telephone Number	:	860-257-9201
Fax Number	:	860-721-6362

Provider Business Practice Location Address
First Line	:	409 VT ROUTE 30 S
Second Line	:
City	:	POULTNEY
State	:	VT
Zip	:	05764-9015
Country	:	US
Telephone Number	:	802-287-5575
Fax Number	:	802-287-2207

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MS. MARY T GENTILE
Credential	:
Telephone Number	:	860-257-9201

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	05/05/2008

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