=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467903898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOTHILLS MEDICAL TRANSPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2016
-----------------------------------------------------
Last Update Date | 10/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6458 E MARTINSBURG RD LOT 2
-----------------------------------------------------
City | LOWVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13367-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-777-5435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6458 E MARTINSBURG RD LOT 2
-----------------------------------------------------
City | LOWVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13367-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-777-5435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | MR. ALVIN LAWRENCE ALDRICH JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-777-5435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 39486
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------