Basic Information
| Provider Information | |||||||||
| NPI: | 1790775187 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAFFREY-RINDGE MEMORIAL AMBULANCE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PHOENIX MILL LN UNIT 200 | ||||||||
| Address2: | |||||||||
| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034581445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039247797 | ||||||||
| FaxNumber: | 6038222813 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | JAFFREY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034526140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035326868 | ||||||||
| FaxNumber: | 6035326868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 01/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED AGENT | ||||||||
| AuthorizedOfficialTelephone: | 6039247797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 0056 | NH | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 30822415 | 05 | NH | MEDICAID | P00215540 | 01 | NH | RAILROAD MEDICARE | OTHER |