Provider Demographics
NPI:1043211618
Name:CITY OF SO BURLINGTON
Entity Type:Organization
Organization Name:CITY OF SO BURLINGTON
Other - Org Name:SO BURLINGTON FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF FIRE & EMS
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-863-4110
Mailing Address - Street 1:575 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6260
Mailing Address - Country:US
Mailing Address - Phone:802-846-4110
Mailing Address - Fax:802-846-4125
Practice Address - Street 1:575 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6260
Practice Address - Country:US
Practice Address - Phone:802-846-4110
Practice Address - Fax:802-846-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0338341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02623141OtherMEDICAID
MA1720546OtherMEDICAID
VT0AM0186Medicaid
0AM0186OtherMAIL HANDLER'S BENEFIT PL
373021OtherMVP
VT68195OtherBCBS
NH30823338OtherMEDICAID
P00152414OtherRAILROAD MEDICARE
VT0AM0186Medicaid