1336114982 NPI number — VILLAGE AMBULANCE SERVICE, INC.

Table of Contents

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: 3894 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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" .

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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