Provider Demographics
NPI:1356410286
Name:CAMBRIDGE RESCUE SQUAD INC.
Entity type:Organization
Organization Name:CAMBRIDGE RESCUE SQUAD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:SEVERANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-644-2113
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05464-0431
Mailing Address - Country:US
Mailing Address - Phone:802-644-2113
Mailing Address - Fax:
Practice Address - Street 1:18 WILLIAMSON COURT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464
Practice Address - Country:US
Practice Address - Phone:802-644-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT19659OtherID NUMBER
VT0VN0774Medicaid
VTCA-AM0221Medicare ID - Type Unspecified