Healthcare Provider Details

I. General information

NPI: 1629090576
Provider Name (Legal Business Name): WATERFORD RESCUE SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 4TH ST
WATERFORD NY
12188-2327
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 518-237-2473
  • Fax: 518-235-0084
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 Number10789
License Number StateNY

VIII. Authorized Official

Name: TRACY ANN WEIR
Title or Position: COO
Credential:
Phone: 518-237-2473