Provider Demographics
NPI:1437188398
Name:LAMOILLE AMBULANCE SERVICE,INC.
Entity Type:Organization
Organization Name:LAMOILLE AMBULANCE SERVICE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:OHALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-635-7724
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-0352
Mailing Address - Country:US
Mailing Address - Phone:802-635-7724
Mailing Address - Fax:802-635-2050
Practice Address - Street 1:93 LOWER MAIN WEST
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656-0352
Practice Address - Country:US
Practice Address - Phone:802-635-7724
Practice Address - Fax:802-635-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01347442Medicaid
VT0006452Medicaid
NY01347442Medicaid
NYCC3505Medicare ID - Type UnspecifiedMEDICARE
NY01347442Medicaid