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General NPI Number Information
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NPI Number | 1821530544
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PARK EMS
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Dates
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Enumeration Date | 11/11/2016
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 1623 MAIN ST
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City | AGAWAM
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State | MA
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Zip | 01001-2512
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Country | US
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Telephone | 413-786-9300
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Fax | 413-786-6324
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Provider Business Mailing Address
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Address Line | 1623 MAIN ST
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City | AGAWAM
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State | MA
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Zip | 01001-2512
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Country | US
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Telephone | 413-786-9300
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Fax | 413-786-6324
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Authorized Official
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Title or Position | ALS COORDINATOR
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Name | MR. JONATHAN HALL
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Credential | PARAMEDIC
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Telephone | 413-786-9300
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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 | 3985
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 3985
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License Number State | MA
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