=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588616577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN ONONDAGA VOLUNTEER AMBULANCE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 04/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4425 BUCKLEY RD
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13090-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-622-1443
-----------------------------------------------------
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 | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JOHN MARKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-622-1443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 10492
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------