Healthcare Provider Details

I. General information

NPI: 1396175923
Provider Name (Legal Business Name): TOWN OF PROVIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7187 BARKERSVILLE RD
MIDDLE GROVE NY
12850-1406
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 518-882-6541
  • Fax:
Mailing address:
  • Phone: 800-927-5845
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6246
License Number StateNY

VIII. Authorized Official

Name: SUSAN WEMPLE
Title or Position: TOWN SUPERVISOR
Credential:
Phone: 518-882-6541