1336114982 NPI number — VILLAGE AMBULANCE SERVICE, INC.

Table of content: (NPI 1336114982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336114982 NPI number — VILLAGE AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE 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:
1336114982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 WASHINGTON AVE
Provider Second Line Business Mailing Address:
VILLAGE AMBULANCE C/O FASNY CREDIT UNION
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12210-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-458-4889
Provider Business Mailing Address Fax Number:
413-458-8476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 WATER ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-458-4889
Provider Business Practice Location Address Fax Number:
413-458-8476
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WITKOWSKI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
413-458-4889

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3894 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1205 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: 1234 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: 1205 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 3894 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 040459 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1709593 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 756911 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 610774700 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803149 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA0783 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00774456 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110030922A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000568 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000024911 . This is a "BMC HEALTHNET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701581 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: A1071632 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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