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General NPI Number Information
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NPI Number | 1629090576
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Entity Type | Organization
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Legal Business Name | WATERFORD RESCUE SQUAD INC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 46 4TH ST
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City | WATERFORD
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State | NY
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Zip | 12188-2327
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Country | US
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Telephone | 518-237-2473
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Fax | 518-235-0084
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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 | 13027-0535
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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 | COO
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Name | TRACY ANN WEIR
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Credential |
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Telephone | 518-237-2473
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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 | 10789
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License Number State | NY
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