Healthcare Provider Details

I. General information

NPI: 1619965068
Provider Name (Legal Business Name): WATERVILLE AREA VOLUNTEER AMBULANCE CORP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7769 STATE ROUTE 20
WATERVILLE NY
13480-2205
US

IV. Provider business mailing address

PO BOX 4066
UTICA NY
13504-4066
US

V. Phone/Fax

Practice location:
  • Phone: 315-841-4400
  • Fax: 315-841-4400
Mailing address:
  • Phone: 315-724-6619
  • Fax: 315-797-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3229
License Number StateNY

VIII. Authorized Official

Name: MR. GARY E ORENDORFF
Title or Position: PRESIDENT OF BOARD
Credential:
Phone: 315-861-7604