Healthcare Provider Details

I. General information

NPI: 1215999669
Provider Name (Legal Business Name): LAKE GEORGE POST NO. 374 AMERICAN LEGION EMERGENCY SQUAD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GAGE RD
LAKE GEORGE NY
12845-6130
US

IV. Provider business mailing address

107 WASHINGTON AVE
ALBANY NY
12210-2269
US

V. Phone/Fax

Practice location:
  • Phone: 518-668-9506
  • Fax: 518-668-5898
Mailing address:
  • Phone: 518-668-9506
  • Fax: 518-668-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10256
License Number StateNY

VIII. Authorized Official

Name: BRUCE W KILBURN
Title or Position: PRESIDENT
Credential:
Phone: 518-668-9506