Healthcare Provider Details

I. General information

NPI: 1972570695
Provider Name (Legal Business Name): TRI-COMMUNITY AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 WARD RD
SANBORN NY
14132-9232
US

IV. Provider business mailing address

8020 E MAIN RD
LE ROY NY
14482-9704
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-2192
  • Fax:
Mailing address:
  • Phone: 585-768-2192
  • Fax: 585-768-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3112
License Number StateNY

VIII. Authorized Official

Name: KENNY DEVOLE
Title or Position: PRESIDENT
Credential:
Phone: 585-768-2192