Healthcare Provider Details

I. General information

NPI: 1285622654
Provider Name (Legal Business Name): CLYDE FIRE DEPT AMB SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FORD ST
CLYDE NY
14433-1306
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 315-923-7667
  • Fax: 315-923-7419
Mailing address:
  • Phone: 800-452-8191
  • Fax: 860-721-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number5814
License Number StateNY

VIII. Authorized Official

Name: MS. HEATHER M LIZOTTE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 800-452-8191