=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326430331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERGENCY SQUAD NO 1 OF SIDNEY FIRE DEPT OF THE VILLAGE OF SIDNEY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2015
-----------------------------------------------------
Last Update Date | 05/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 PATTERSON ST
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13838-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-244-7640
-----------------------------------------------------
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 | BOARD PRESIDENT
-----------------------------------------------------
Name | MR. RAYMOND E BAKER JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-561-2316
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------