1568446375 NPI number — EAST AREA VOLUNTEER EMERGENCY 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 1568446375 NPI number — EAST AREA VOLUNTEER EMERGENCY SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST AREA VOLUNTEER EMERGENCY 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:
EAVES AMBULANCE
Provider Other Organization Name Type Code:
3
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:
1568446375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 535
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWINSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13027-0535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-635-1789
Provider Business Mailing Address Fax Number:
315-635-3289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6232 FLY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-9337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-437-0939
Provider Business Practice Location Address Fax Number:
315-463-9220
Provider Enumeration Date:
12/05/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEBSTER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
315-437-0939

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  09657 , 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: 955178 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01612000 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119401900 . This is a "US DEPT OF LABOR OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9602731 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590009977 . This is a "PALMETTO GBA RAILROAD" identifier . This identifiers is of the category "OTHER".