Healthcare Provider Details

I. General information

NPI: 1053394239
Provider Name (Legal Business Name): CHAMPLAIN EMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 STATE ROUTE 11
CHAMPLAIN NY
12919-4526
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 518-298-5911
  • Fax: 518-298-3918
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 Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00122123
Identifier TypeOTHER
Identifier State
Identifier IssuerPALMETTO GBA-RAILROAD
# 2
Identifier02568050
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: CORY THOMPSON
Title or Position: PRESIDENT
Credential:
Phone: 518-298-5911