Healthcare Provider Details

I. General information

NPI: 1902848799
Provider Name (Legal Business Name): SOUTHERN OSWEGO VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 GERTRUDE DR
CENTRAL SQUARE NY
13036-2600
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 315-676-5071
  • Fax:
Mailing address:
  • Phone: 315-635-1789
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10751
License Number StateNY

VIII. Authorized Official

Name: MICHAEL MONTGOMERY JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 315-676-5071