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General NPI Number Information
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NPI Number | 1891474425
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Entity Type | Organization
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Legal Business Name | MAUDE AMBULANCE CO LLC
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 20407 119TH AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3558
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Country | US
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Telephone | 191-725-7360
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Fax |
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Provider Business Mailing Address
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Address Line | 20407 119TH AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3558
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Country | US
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Telephone | 191-725-7360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEMONE MELLESSA LEWIS-GRAY
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Credential |
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Telephone | 917-257-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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