MEDICARE: LAKESHORE VOLUNTEER AMBULANCE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1069	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590012016	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083604540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE VOLUNTEER AMBULANCE INC

Provider Business Mailing Address
First Line	:	8020 E MAIN RD
Second Line	:
City	:	LE ROY
State	:	NY
Zip	:	14482-9704
Country	:	US
Telephone Number	:	585-768-2192
Fax Number	:	585-768-7323

Provider Business Practice Location Address
First Line	:	5841 NEW HARTFORD ST
Second Line	:
City	:	WOLCOTT
State	:	NY
Zip	:	14590-1136
Country	:	US
Telephone Number	:	315-754-6489
Fax Number	:	315-754-8453

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. GEORGE LOCKWOOD
Credential	:
Telephone Number	:	315-594-9393

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	06/18/2014

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Directions to “LAKESHORE VOLUNTEER AMBULANCE INC ” Practice Location

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