Healthcare Provider Details

I. General information

NPI: 1306862867
Provider Name (Legal Business Name): THOUSAND ISLANDS EMERGENCY RESCUE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UNION STREET
CLAYTON NY
13624-9998
US

IV. Provider business mailing address

8020 E MAIN RD
LE ROY NY
14482-9704
US

V. Phone/Fax

Practice location:
  • Phone: 315-686-4333
  • Fax: 315-686-4344
Mailing address:
  • Phone: 585-768-2192
  • Fax: 585-768-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10174
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0741
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL BENNETT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 315-686-4333