Healthcare Provider Details

I. General information

NPI: 1790847770
Provider Name (Legal Business Name): R.B. LAWRENCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5747 US HIGHWAY 11
CANTON NY
13617
US

IV. Provider business mailing address

21 OSWEGO ST PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-3909
  • Fax:
Mailing address:
  • Phone: 800-927-5845
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number4441
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberD376796
License Number StateNY

VIII. Authorized Official

Name: MR. RUSSELL B. LAWRENCE III
Title or Position: PRESIDENT
Credential:
Phone: 315-375-8258