1912058207 NPI number — HOOSIC VALLEY RESCUE SQUAD

Table of content: (NPI 1912058207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912058207 NPI number — HOOSIC VALLEY RESCUE SQUAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOOSIC VALLEY RESCUE SQUAD
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:
1912058207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5530 SHERIDAN DRIVE
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:
14201-3730
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:
1448 NY ROUTE 40
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHAGHTICOKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12154-0041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-753-6634
Provider Business Practice Location Address Fax Number:
518-573-6942
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RYAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
518-753-6634

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  4123 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01514525 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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