Healthcare Provider Details

I. General information

NPI: 1336137884
Provider Name (Legal Business Name): ELLICOTTVILLE GREAT VALLEY AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FILMORE AVE
ELLICOTTVILLE NY
14731-0074
US

IV. Provider business mailing address

555 INTERNATIONAL DR
WILLIAMSVILLE NY
14221-5723
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-1398
  • Fax: 716-945-3340
Mailing address:
  • Phone: 716-204-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0427
License Number StateNY

VIII. Authorized Official

Name: MR. STEPHEN WARD
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 716-699-2300