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General NPI Number Information
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NPI Number | 1972793602
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Entity Type | Organization
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Legal Business Name | BLACK RIVER AMBULANCE SQUAD, INC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 121 LERAY ST
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City | BLACK RIVER
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State | NY
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Zip | 13612-2114
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Country | US
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Telephone | 315-773-4501
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Fax | 315-775-0291
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Provider Business Mailing Address
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Address Line | 121 LERAY ST PO BOX 314
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City | BLACK RIVER
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State | NY
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Zip | 13612-2114
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Country | US
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Telephone | 315-773-4501
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Fax | 315-775-0291
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Authorized Official
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Title or Position | BILLING OFFICER
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Name | MR. ALAN CLAUDE GAINES
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Credential |
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Telephone | 315-773-4501
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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 | 2232
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License Number State | NY
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