Healthcare Provider Details

I. General information

NPI: 1255634606
Provider Name (Legal Business Name): 342-ABUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 COUNTY ROUTE 1A
OSWEGO NY
13126-5931
US

IV. Provider business mailing address

PO BOX 59
MEXICO NY
13114-0059
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-2287
  • Fax:
Mailing address:
  • Phone: 315-342-2287
  • Fax: 866-247-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number38054
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number38054
License Number StateNY

VIII. Authorized Official

Name: MR. ALLEN CHASE
Title or Position: PRESIDENT
Credential:
Phone: 315-342-2287