Organization
DERBY LINE AMBULANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PARADIS (CEO)
(802) 334-2023
Entity
Organization
Contact information
Practice address
67 BEECH ST, DERBY LINE, VT 05830-9302
(802) 334-2023
Mailing address
PO BOX 911, NEWPORT, VT 05855-0911
(802) 334-2023
(802) 334-7536
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0204
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006385
MAIN PROVIDER
VT
05
—
DERB6385
—
VT
Enumeration date
06/17/2006
Last updated
08/29/2017
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