1942290408 NPI number — NATURAL BRIDGE VOLUNTEER AMBULANCE, INC.

Table of content: (NPI 1942290408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942290408 NPI number — NATURAL BRIDGE VOLUNTEER AMBULANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATURAL BRIDGE VOLUNTEER AMBULANCE, 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:
1942290408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 263
Provider Second Line Business Mailing Address:
27570 HIGH STREET
Provider Business Mailing Address City Name:
NATURAL BRIDGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-644-9898
Provider Business Mailing Address Fax Number:
315-644-4444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2750 HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATURAL BRIDGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13665-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-644-9898
Provider Business Practice Location Address Fax Number:
315-644-4444
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MANUEL
Authorized Official First Name:
MOLLY
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
EMS CHIEF
Authorized Official Telephone Number:
315-644-9898

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0722 , 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: 02684100 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00076396 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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