=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164971701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF NIAGARA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2016
-----------------------------------------------------
Last Update Date | 09/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6010 LOCKPORT ROAD
-----------------------------------------------------
City | NIAGARA FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-565-6200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 535
-----------------------------------------------------
City | BALDWINSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13027-0535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-635-1789
-----------------------------------------------------
Fax | 315-635-3289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TOWN SUPERVISOR
-----------------------------------------------------
Name | MR. LEE S. WALLACE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-297-2150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 33543
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------