1730179128 NPI number — LANCASTER VOLUNTEER AMBULANCE CORPS, INC.

Table of content: (NPI 1730179128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730179128 NPI number — LANCASTER VOLUNTEER AMBULANCE CORPS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANCASTER 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:
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:
1730179128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8610 MAIN STREET
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:
40 EMBRY PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14086-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-683-3282
Provider Business Practice Location Address Fax Number:
716-683-5466
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
POPOILKOWSKI
Authorized Official First Name:
CHESTER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-341-5372

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1484 , 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: 1730179128 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590007543 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01377522 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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