Provider Demographics
NPI:1407832819
Name:ALBURG VOLUNTEER FIRE DEPARTMENT, INC.
Entity Type:Organization
Organization Name:ALBURG VOLUNTEER FIRE DEPARTMENT, INC.
Other - Org Name:ALBURG RESCUE
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GOTSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-338-7482
Mailing Address - Street 1:60 FIREHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ALBURGH
Mailing Address - State:VT
Mailing Address - Zip Code:05440-4403
Mailing Address - Country:US
Mailing Address - Phone:802-796-3402
Mailing Address - Fax:802-796-3162
Practice Address - Street 1:60 FIREHOUSE RD
Practice Address - Street 2:
Practice Address - City:ALBURG
Practice Address - State:VT
Practice Address - Zip Code:05440-4403
Practice Address - Country:US
Practice Address - Phone:802-338-7482
Practice Address - Fax:802-796-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTALBU29430OtherBLUE CROSS
VTOVN1520Medicaid
VTAM0123Medicare ID - Type Unspecified