MEDICARE: FORT EDWARD 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	341600000X	Ambulance	09742	NY
2	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000400562001	OTHER	BS OF NORTHEASTERN NY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9718591	OTHER	GHI
4	590011143	OTHER	PALMETTO GBA RAILROAD
5	10023189	OTHER	CDPHP
6	958571	OTHER	MVP

General Provider Information

NPI Number	:	1427031319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT EDWARD RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	5530 SHERIDAN DR
Second Line	:	SUITE 3B
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-3730
Country	:	US
Telephone Number	:	716-204-3350
Fax Number	:	716-634-7170

Provider Business Practice Location Address
First Line	:	75 SCHUYLER STREET
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828
Country	:	US
Telephone Number	:	518-747-6198
Fax Number	:	518-746-9479

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DELLA STINE
Credential	:
Telephone Number	:	518-747-6198

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	12/22/2016

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Directions to “FORT EDWARD RESCUE SQUAD INC ” Practice Location

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