1699047118 NPI number — BOLTON EMERGENCY MEDICAL SERVICES, INCORPORATED

Table of content: (NPI 1699047118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699047118 NPI number — BOLTON EMERGENCY MEDICAL SERVICES, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOLTON EMERGENCY MEDICAL SERVICES, INCORPORATED
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:
1699047118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLTON LANDING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12814-1054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-644-3071
Provider Business Mailing Address Fax Number:
518-644-3074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5003 LAKE SHORE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLTON LANDING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12814-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-644-3071
Provider Business Practice Location Address Fax Number:
518-644-3074
Provider Enumeration Date:
01/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MIKOLOSKI
Authorized Official First Name:
EARL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OPERATIONS ADMINISTRATOR
Authorized Official Telephone Number:
518-644-9283

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0977 , 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)





Copyright © 2007-2025 www.npivalidator.com