Healthcare Provider Details

I. General information

NPI: 1336115336
Provider Name (Legal Business Name): AVON ROTARY-LIONS AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 GENESEE ST
AVON NY
14414-1220
US

IV. Provider business mailing address

PO BOX 186
LE ROY NY
14482-0186
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-2192
  • Fax:
Mailing address:
  • Phone: 585-768-2192
  • Fax: 585-768-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2512
License Number StateNY

VIII. Authorized Official

Name: JAMES CORCORAN
Title or Position: PRESIDENT
Credential:
Phone: 585-768-2192