1053318998 NPI number — UNION VOLUNTEER EMERGENCY SQUAD, INC.

Table of content: (NPI 1053318998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053318998 NPI number — UNION VOLUNTEER EMERGENCY SQUAD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION VOLUNTEER EMERGENCY SQUAD, 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:
1053318998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8739
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENDWELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13762-8739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-754-3414
Provider Business Mailing Address Fax Number:
607-754-3657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 S. AVE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENDWELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-754-3414
Provider Business Practice Location Address Fax Number:
607-754-3657
Provider Enumeration Date:
07/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FELLOWS
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
607-786-7502

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  10292 , 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: 91048 , 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: 0331 , 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: 01365324 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".