Healthcare Provider Details

I. General information

NPI: 1306813118
Provider Name (Legal Business Name): PENFIELD VOLUNTEER EMERGENCY AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 JACKSON ROAD
PENFIELD NY
14526-0220
US

IV. Provider business mailing address

8610 MAIN STREET
WILLIAMSVILLE NY
14221-7455
US

V. Phone/Fax

Practice location:
  • Phone: 585-872-6060
  • Fax: 585-872-2105
Mailing address:
  • Phone: 716-204-3350
  • Fax: 716-247-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2729
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number33348
License Number StateNY

VIII. Authorized Official

Name: MR. RICHARD GLYNNE JONES
Title or Position: TREASURER
Credential:
Phone: 585-872-6060