Healthcare Provider Details

I. General information

NPI: 1225331200
Provider Name (Legal Business Name): INDIAN RIVER AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANTWERP STREET
PHILADELPHIA NY
13673
US

IV. Provider business mailing address

8020 E MAIN RD
LE ROY NY
14482-9704
US

V. Phone/Fax

Practice location:
  • Phone: 315-530-3026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0952
License Number StateNY

VIII. Authorized Official

Name: LANCE RONAS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 315-530-3026