1538100284 NPI number — BLOOMING GROVE VOLUNTEER AMBULANCE CORPS INC

Table of content: (NPI 1538100284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538100284 NPI number — BLOOMING GROVE VOLUNTEER AMBULANCE CORPS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOMING GROVE VOLUNTEER AMBULANCE CORPS 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:
1538100284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2014
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:
7 NORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTONVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-496-9281
Provider Business Practice Location Address Fax Number:
845-497-3185
Provider Enumeration Date:
06/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BATES
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
845-497-3186

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 31217 , 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: 02065598 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".