Provider Demographics
NPI:1982668620
Name:TOWN OF MONTGOMERY
Entity Type:Organization
Organization Name:TOWN OF MONTGOMERY
Other - Org Name:MONTGOMERY RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SCHEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMTI03
Authorized Official - Phone:802-326-4058
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05471-0356
Mailing Address - Country:US
Mailing Address - Phone:802-326-4719
Mailing Address - Fax:802-326-4939
Practice Address - Street 1:86 MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CENTER
Practice Address - State:VT
Practice Address - Zip Code:05471
Practice Address - Country:US
Practice Address - Phone:802-326-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0121341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT05939111OtherBLUE CROSS
VTOAM0042Medicaid
VTOAM0042Medicaid