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General NPI Number Information
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NPI Number | 1104376433
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Entity Type | Organization
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Legal Business Name | TOWN OF CLINTON
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 23 SMITH STREET
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City | CHURUBUSCO
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State | NY
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Zip | 12923-0165
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Country | US
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Telephone | 518-497-6133
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Fax | 518-497-6053
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Provider Business Mailing Address
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Address Line | PO BOX 165 23 SMITH STREET
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City | CHURUBUSCO
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State | NY
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Zip | 12923-0165
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Country | US
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Telephone | 518-497-6133
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Fax | 518-497-6053
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Authorized Official
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Title or Position | TOWN SUPERVISOR
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Name | DANIEL LACLAIR
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Credential |
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Telephone | 518-497-6133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 33486
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License Number State | NY
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