Provider Demographics
NPI:1053394973
Name:TOWN OF SHELBURNE
Entity type:Organization
Organization Name:TOWN OF SHELBURNE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-985-5125
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-0254
Mailing Address - Country:US
Mailing Address - Phone:802-985-5125
Mailing Address - Fax:802-985-5128
Practice Address - Street 1:154 TURTLE LANE
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482
Practice Address - Country:US
Practice Address - Phone:802-985-5125
Practice Address - Fax:802-985-5128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF SHELBURNE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-23
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT03233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2534OtherBLUE CROSS
VTOAM0136Medicaid
VTOAM0136Medicaid