MEDICARE: EAST ROCHESTER VOLUNTEER AMBULANCE CORPS 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	2720	NY

General Provider Information

NPI Number	:	1144297870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST ROCHESTER VOLUNTEER AMBULANCE CORPS INC.

Provider Business Mailing Address
First Line	:	PO BOX 186
Second Line	:
City	:	LE ROY
State	:	NY
Zip	:	14482-0186
Country	:	US
Telephone Number	:	585-768-2192
Fax Number	:	585-768-7323

Provider Business Practice Location Address
First Line	:	254 W IVY ST
Second Line	:
City	:	EAST ROCHESTER
State	:	NY
Zip	:	14445-1818
Country	:	US
Telephone Number	:	585-768-2192
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	JULIE GANGEMI
Credential	:
Telephone Number	:	585-768-2192

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	10/25/2007

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