1114021219 NPI number — NORTH QUEENSBURY VOLUNTEER RESCUE SQUAD INC

Table of content: (NPI 1114021219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114021219 NPI number — NORTH QUEENSBURY VOLUNTEER RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH QUEENSBURY VOLUNTEER RESCUE 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:
1114021219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 676
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENS FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12801-0676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-603-2455
Provider Business Mailing Address Fax Number:
518-391-2601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 9 BOX 272
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVERDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-656-9525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OWEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-603-2455

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , 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: 02654171 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".