1043294614 NPI number — KUYAHOORA VOLUNTEER AMBULANCE CORPS INC

Table of content: (NPI 1043294614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043294614 NPI number — KUYAHOORA VOLUNTEER AMBULANCE CORPS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUYAHOORA 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:
6
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:
1043294614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8610 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-7455
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:
39 CASE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-826-3525
Provider Business Practice Location Address Fax Number:
315-826-5695
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEIDELBERGER
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
315-826-3525

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  10230 , 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: 9602732 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01564089 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950957 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590009493 . This is a "PALMETTO GBA RAILROAD" identifier . This identifiers is of the category "OTHER".




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