Healthcare Provider Details

I. General information

NPI: 1245265115
Provider Name (Legal Business Name): PENN YAN AREA VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 MAIN ST
PENN YAN NY
14527-1679
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-2714
  • Fax:
Mailing address:
  • Phone: 315-635-1789
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10083
License Number StateNY

VIII. Authorized Official

Name: MARY STARKWEATHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 315-536-2714