Healthcare Provider Details

I. General information

NPI: 1538188834
Provider Name (Legal Business Name): OTISVILLE MT. HOPE VOLUNTEER AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 STATE STR
OTISVILLE NY
10963
US

IV. Provider business mailing address

PO BOX 196
OTISVILLE NY
10963-0196
US

V. Phone/Fax

Practice location:
  • Phone: 845-386-9501
  • Fax: 845-386-1244
Mailing address:
  • Phone: 845-386-9501
  • Fax: 845-386-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number10041
License Number StateNY

VIII. Authorized Official

Name: MR. LOU DODD
Title or Position: PRESIDENT
Credential:
Phone: 845-386-9501