Healthcare Provider Details

I. General information

NPI: 1073589941
Provider Name (Legal Business Name): TRI TOWN AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8935 RIDGE RD
GASPORT NY
14067-9413
US

IV. Provider business mailing address

8020 E MAIN RD
LE ROY NY
14482-9704
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-2192
  • Fax:
Mailing address:
  • Phone: 585-768-2192
  • Fax: 585-768-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3129
License Number StateNY

VIII. Authorized Official

Name: HOWARD MERICLE
Title or Position: PRESIDENT
Credential:
Phone: 585-768-2192