Provider Demographics
NPI:1508990813
Name:SPENCER RESCUE & EMERGENCY SQUAD, INC.
Entity Type:Organization
Organization Name:SPENCER RESCUE & EMERGENCY SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-885-4476
Mailing Address - Street 1:6 BIXBY RD
Mailing Address - Street 2:P.O. BOX 147
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2402
Mailing Address - Country:US
Mailing Address - Phone:508-885-4476
Mailing Address - Fax:508-885-0315
Practice Address - Street 1:9 MAIN ST STE 2K
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-1660
Practice Address - Country:US
Practice Address - Phone:508-476-9740
Practice Address - Fax:508-476-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000005959OtherBLUE CROSS BLUE SHIELD
MA1700847Medicaid
MA1700847Medicaid