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General NPI Number Information
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NPI Number | 1477824969
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Entity Type | Organization
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Legal Business Name | COVENTRY EMERGENCY SQUAD, INC.
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 109 NORTH RD
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City | GREENE
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State | NY
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Zip | 13778-2377
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Country | US
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Telephone | 607-371-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 109 NORTH RD
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City | GREENE
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State | NY
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Zip | 13778-2377
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Country | US
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Telephone | 607-371-1141
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KYLE WEARNE
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Credential |
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Telephone | 607-371-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 30300
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License Number State | NY
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