MEDICARE: JOHNSTOWN AREA 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	341600000X	Ambulance	1713	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590011684	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1235129628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSTOWN AREA VOLUNTEER AMBULANCE CORPS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-0429
Country	:	US
Telephone Number	:	518-235-7670
Fax Number	:	518-235-7601

Provider Business Practice Location Address
First Line	:	231 N PERRY ST
Second Line	:
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-1216
Country	:	US
Telephone Number	:	518-762-9120
Fax Number	:	518-736-1006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LUCAS PASZKIEWICZ
Credential	:
Telephone Number	:	518-762-9120

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/24/2014

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