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General NPI Number Information
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NPI Number | 1508895293
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Entity Type | Organization
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Legal Business Name | PHILMONT RESCUE SQUAD INC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4 MAPLE AVE
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City | PHILMONT
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State | NY
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Zip | 12565
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Country | US
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Telephone | 518-672-7401
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | BALDWINSVILLE
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State | NY
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Zip | 13027
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Country | US
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Telephone | 315-635-1789
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Fax | 315-635-3289
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Authorized Official
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Title or Position | ADMINISTRATOR CAPTAIN
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Name | RICK E TRACEY JR.
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Credential | CCRN EMT
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Telephone | 518-672-6192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 10443
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License Number State | NY
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