Healthcare Provider Details

I. General information

NPI: 1982954806
Provider Name (Legal Business Name): HOUGHTON VOLUNTEER AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 STATE ROUTE 19
HOUGHTON NY
14744
US

IV. Provider business mailing address

9750 STATE ROUTE 19
HOUGHTON NY
14744
US

V. Phone/Fax

Practice location:
  • Phone: 585-567-8229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0953
License Number StateNY

VIII. Authorized Official

Name: ANDREW SMITH
Title or Position: TREASURER
Credential:
Phone: 585-567-8229