Provider Demographics
NPI:1932219961
Name:SOUTHWESTERN VERMONT REGIONAL AMBULANCE, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN VERMONT REGIONAL AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRECHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-447-0413
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-0911
Mailing Address - Country:US
Mailing Address - Phone:802-447-0413
Mailing Address - Fax:802-447-0417
Practice Address - Street 1:405 MORSE RD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1662
Practice Address - Country:US
Practice Address - Phone:802-447-0413
Practice Address - Fax:802-447-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT12133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005052Medicaid
VT70808OtherMOHAWK VALLEY PROVIDER #
VT10025293OtherCAPITAL DISTRICT PHYS HEA
VT28118OtherBCBS PROVIDER NUMBER
VT28118OtherBCBS PROVIDER NUMBER