1528442993 NPI number — TOWN OF HANCOCK VOLUNTEER AMBULANCE CORPS INC

Table of content: (NPI 1528442993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528442993 NPI number — TOWN OF HANCOCK VOLUNTEER AMBULANCE CORPS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF HANCOCK 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:
D/B/A TOWN OF HANCOCK AMBULANCE
Provider Other Organization Name Type Code:
3
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:
1528442993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 535
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWINSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13027-0535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-303-1735
Provider Business Mailing Address Fax Number:
315-635-3289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24501 STATE HIGHWAY 97
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANCOCK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13783-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-637-9926
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OBOYLE
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
607-637-4455

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  32712 , 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: 04293981 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01564567 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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