MEDICARE: NORTH SHORE VOLUNTEER EMERGENCY SQUAD 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	341600000X	Ambulance	10621	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	318534	OTHER	MVP
3	590012354	OTHER	PALMETTO GBA

General Provider Information

NPI Number	:	1104862887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHORE VOLUNTEER EMERGENCY SQUAD INC

Provider Business Mailing Address
First Line	:	PO BOX 535
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-0535
Country	:	US
Telephone Number	:	315-635-1789
Fax Number	:	315-635-3289

Provider Business Practice Location Address
First Line	:	136 BRIDGE ST
Second Line	:
City	:	CLEVELAND
State	:	NY
Zip	:	13042
Country	:	US
Telephone Number	:	315-675-3110
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	DIANE AVERY
Credential	:
Telephone Number	:	315-635-1789

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/27/2012

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