# DERBY LINE AMBULANCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265477012
- **Authorized official:** MICHAEL PARADIS (CEO)
- **Authorized official phone:** (802) 334-2023

## Contact information

- **Practice address:** 67 BEECH ST, DERBY LINE, VT 05830-9302
- **Practice address phone:** (802) 334-2023
- **Mailing address:** PO BOX 911, NEWPORT, VT 05855-0911
- **Mailing address phone:** (802) 334-2023
- **Mailing address fax:** (802) 334-7536

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 0204 | VT | Yes |

## Other

- **Enumeration date:** 06/17/2006
- **Last updated:** 08/29/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0006385 | MAIN PROVIDER | VT |
| 05 | — | DERB6385 | — | VT |