Healthcare Provider Details

I. General information

NPI: 1043294614
Provider Name (Legal Business Name): KUYAHOORA VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CASE STREET
POLAND NY
13431
US

IV. Provider business mailing address

8610 MAIN ST
WILLIAMSVILLE NY
14221-7455
US

V. Phone/Fax

Practice location:
  • Phone: 315-826-3525
  • Fax: 315-826-5695
Mailing address:
  • Phone: 716-204-3350
  • Fax: 716-247-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10230
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DARREN HEIDELBERGER
Title or Position: PRESIDENT
Credential:
Phone: 315-826-3525