Healthcare Provider Details

I. General information

NPI: 1043735491
Provider Name (Legal Business Name): MOHAWK COUNCIL OF AKWESASNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 STATE ROUTE 37
AKWESASNE NY
13655-2175
US

IV. Provider business mailing address

5530 SHERIDAN DR STE 3B
WILLIAMSVILLE NY
14221-3730
US

V. Phone/Fax

Practice location:
  • Phone: 613-575-2341
  • Fax: 613-575-2341
Mailing address:
  • Phone: 716-204-3350
  • Fax: 716-634-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number32787
License Number StateNY

VIII. Authorized Official

Name: JORDAN WAPASS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 613-575-2341