Provider Demographics
NPI:1356325716
Name:MISSISQUOI VALLEY RESCUE, INC.
Entity Type:Organization
Organization Name:MISSISQUOI VALLEY RESCUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:ST. PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I03
Authorized Official - Phone:802-868-4540
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-0022
Mailing Address - Country:US
Mailing Address - Phone:802-868-2352
Mailing Address - Fax:802-868-9092
Practice Address - Street 1:120 1ST ST
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:VT
Practice Address - Zip Code:05488-1115
Practice Address - Country:US
Practice Address - Phone:802-868-2352
Practice Address - Fax:802-868-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006497Medicaid
VTVT6467Medicare PIN