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General NPI Number Information
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NPI Number | 1811671126
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Entity Type | Organization
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Legal Business Name | BOLIVAR FIRE DEPARTMENT, INC.
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 460 MAIN ST
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City | BOLIVAR
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State | NY
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Zip | 14715-1135
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Country | US
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Telephone | 585-928-1250
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Fax | 585-928-1775
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Provider Business Mailing Address
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Address Line | 8610 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-7455
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Country | US
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Telephone | 716-204-3350
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Fax | 716-247-5274
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Authorized Official
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Title or Position | PRESIDENT
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Name | LACEANNE WYCKOFF
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Credential |
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Telephone | 585-928-1250
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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 |
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License Number State |
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