=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235850843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE OF LAKEWOOD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2022
-----------------------------------------------------
Last Update Date | 09/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 W SUMMIT ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14750-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-763-8557
-----------------------------------------------------
Fax | 716-763-4468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8610 MAIN ST
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-7455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-204-3350
-----------------------------------------------------
Fax | 716-247-5274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MAYOR
-----------------------------------------------------
Name | RANDALL G. HOLCOMB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-763-8557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------