Provider Demographics
NPI:1174513634
Name:POWNAL RESCUE SQUAD INCORPORATED
Entity type:Organization
Organization Name:POWNAL RESCUE SQUAD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-823-5200
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:800-473-2278
Mailing Address - Fax:484-664-2015
Practice Address - Street 1:54 LADD ROAD
Practice Address - Street 2:
Practice Address - City:POWNAL
Practice Address - State:VT
Practice Address - Zip Code:05261
Practice Address - Country:US
Practice Address - Phone:802-823-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1207341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590009360OtherRAILROAD MEDICARE
VT0006499Medicaid
VTVT6499Medicare PIN