Provider Demographics
NPI:1962493312
Name:WATERBURY AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:WATERBURY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:802-244-5003
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-0095
Mailing Address - Country:US
Mailing Address - Phone:802-244-5003
Mailing Address - Fax:800-802-6803
Practice Address - Street 1:1727 GUPTIL RD
Practice Address - Street 2:
Practice Address - City:WATERBURY CENTER
Practice Address - State:VT
Practice Address - Zip Code:05677-7094
Practice Address - Country:US
Practice Address - Phone:802-244-5003
Practice Address - Fax:802-244-4929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT06083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006444Medicaid
VT0006444Medicaid