Provider Demographics
NPI:1437139243
Name:SOUTHERN BERKSHIRE VOLUNTEER AMBULANCE SQUAD INC
Entity Type:Organization
Organization Name:SOUTHERN BERKSHIRE VOLUNTEER AMBULANCE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-528-3632
Mailing Address - Street 1:31 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1713
Mailing Address - Country:US
Mailing Address - Phone:413-528-3632
Mailing Address - Fax:413-528-5549
Practice Address - Street 1:31 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1713
Practice Address - Country:US
Practice Address - Phone:413-528-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3365341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
700865OtherHARVARD PILGRIM
744846OtherCONNECTICARE
NY00970558Medicaid
000000022136OtherBMC HEALTHNET PLAN
441590232OtherRR MEDICARE
610068600OtherDEPARTMENT OF LABOR
805052OtherTUFTS HEALTH
0017302OtherNEIGHBORHOOD HEALTH
MA030659OtherBLUE CROSS BLUE SHIELD
MA1705873Medicaid
937093OtherMVP HEALTH CARE
MA1705873Medicaid