Healthcare Provider Details

I. General information

NPI: 1720013329
Provider Name (Legal Business Name): STILLWATER AMBULANCE FUND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 N HUDSON AVE
STILLWATER NY
12170
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 518-664-8012
  • 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 Number10630
License Number StateNY

VIII. Authorized Official

Name: CAROLYN M HAYNER
Title or Position: TREASURER
Credential:
Phone: 518-664-8012