Provider Demographics
NPI:1588691778
Name:FAIRFAX EMS INC
Entity type:Organization
Organization Name:FAIRFAX EMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-849-2773
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-0428
Mailing Address - Country:US
Mailing Address - Phone:802-849-2773
Mailing Address - Fax:
Practice Address - Street 1:14 GOODALL STREET
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VT
Practice Address - Zip Code:05454-0428
Practice Address - Country:US
Practice Address - Phone:802-334-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006474OtherMAIN PROVIDER NUMBER
VT0006474Medicaid
VT0006474Medicaid