Healthcare Provider Details

I. General information

NPI: 1003845736
Provider Name (Legal Business Name): SKENESBOROUGH EMERGENCY SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SKENESBOROUGH DR
WHITEHALL NY
12887
US

IV. Provider business mailing address

107 WASHINGTON AVE
ALBANY NY
12210-2231
US

V. Phone/Fax

Practice location:
  • Phone: 315-499-2122
  • Fax:
Mailing address:
  • Phone: 888-603-2455
  • Fax: 888-603-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10696
License Number StateNY

VIII. Authorized Official

Name: MR. BRANDON PAUL SPARKS
Title or Position: CAPTAIN
Credential:
Phone: 518-499-2122