1013984921 NPI number — GREECE VOLUNTEER AMBULANCE SERVICE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013984921 NPI number — GREECE VOLUNTEER AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREECE VOLUNTEER AMBULANCE SERVICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013984921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5530 SHERIDAN DR
Provider Second Line Business Mailing Address:
SUITE 3B
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-204-3350
Provider Business Mailing Address Fax Number:
716-247-5274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
867 LONG POND ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREECE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-227-2073
Provider Business Practice Location Address Fax Number:
585-227-5406
Provider Enumeration Date:
03/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BORTLE
Authorized Official First Name:
JASON
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
MANAGING EMPLOYEE
Authorized Official Telephone Number:
585-227-2073

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2722 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 30721 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01544843 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: PGREECEVOLA . This is a "MONROE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".