MEDICARE: ELLENVILLE FIRST AID & RESCUE 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	3416L0300X	Land Ambulance	5515	NY

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	:	1215925763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLENVILLE FIRST AID & RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	PO BOX 207
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18105-0207
Country	:	US
Telephone Number	:	484-664-2007
Fax Number	:	484-664-2015

Provider Business Practice Location Address
First Line	:	1 WEBSTER ST
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1109
Country	:	US
Telephone Number	:	845-647-8181
Fax Number	:	845-647-3947

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. STEVE GRUNDT
Credential	:
Telephone Number	:	845-647-8181

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	10/11/2012

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