Healthcare Provider Details

I. General information

NPI: 1235129701
Provider Name (Legal Business Name): LAKE PLACID VOLUNTEER AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 MILL POND DRIVE
LAKE PLACID NY
12946
US

IV. Provider business mailing address

107 WASHINGTON AVE
ALBANY NY
12210-2200
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-9512
  • Fax: 518-523-5379
Mailing address:
  • Phone: 888-603-2455
  • Fax: 888-603-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1530
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: HANNAH E MARSHALL
Title or Position: TREASURER
Credential: CPA
Phone: 518-523-8052