Provider Demographics
NPI:1831286590
Name:MANCHESTER RESCUE SQUAD INC
Entity Type:Organization
Organization Name:MANCHESTER RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:CCEMTP
Authorized Official - Phone:802-362-1995
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:C O NEAB
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-0153
Mailing Address - Country:US
Mailing Address - Phone:802-877-2429
Mailing Address - Fax:802-877-2292
Practice Address - Street 1:6041 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-0026
Practice Address - Country:US
Practice Address - Phone:802-362-1995
Practice Address - Fax:802-362-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1203341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006364Medicaid
VT00006364OtherBLUE CROSS BLUE SHIELD
VT0006364Medicaid