Healthcare Provider Details

I. General information

NPI: 1326166471
Provider Name (Legal Business Name): TOWN OF LIVONIA AMBULANCE DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 SOUTH LIVONIA RD.
LIVONIA NY
14487
US

IV. Provider business mailing address

PO BOX 186
LE ROY NY
14482-0186
US

V. Phone/Fax

Practice location:
  • Phone: 585-753-3714
  • 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 Number0806
License Number StateNY

VIII. Authorized Official

Name: MARC CONNOLLY
Title or Position: CHAIRMAN
Credential:
Phone: 585-753-3714