=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477536381
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORT ANN RESCUE SQUAD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 12/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11287 STATE ROUTE 149
-----------------------------------------------------
City | FORT ANN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-639-1005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8610 MAIN STREET
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-7455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-204-3350
-----------------------------------------------------
Fax | 716-247-5274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JORDAN T. NEUMANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-639-1005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 10258
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------