Waterbury Ambulance Service, Inc.
Organization Active NPI Land Ambulance · Waterbury Center, VT
NPI 1962493312 · NPPES record last updated Nov 15, 2010
Key facts
- NPI
- 1962493312
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 0608 (VT)
- Legal business name
- WATERBURY AMBULANCE SERVICE, INC.
- Practice address
- 1727 Guptil Rd
Waterbury Center, VT 05677-7094 - Phone
- (802) 244-5003
- Fax
- (802) 244-4929
- NPI assigned
- Nov 3, 2005
- Organization subpart
- No
Authorized official
- Name
- John H Kueffner, EMT-I
- Title
- Vice President
- Phone
- (802) 244-5003
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 47D1098550 | Waterbury Ambulance Service Inc | Certificate of waiver | Nov 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070718000469 | VT | Part B Supplier - Ambulance Service Supplier | 6901907138 | Practice locations: Waterbury Center, VT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 0608 | VT | Yes |
Addresses
Primary practice location
1727 Guptil Rd
Waterbury Center, VT 05677-7094
Mailing address
PO Box 95
Waterbury Center, VT 05677-0095
Phone (802) 244-5003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006444 | Medicaid | VT |
Other providers in Waterbury Center, VT
- Orthopedic Solutions Vermont LLC
- Lindsay Pokorak
- Ilana Scharoun
- Thomas Scribner
- Tracy Sweeney
- Michael Anthony Zacharias
All providers in Waterbury Center, VT · Land Ambulance in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.