MEDICARE: COVENTRY 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	3416L0300X	Land Ambulance	30300	NY

General Provider Information

NPI Number	:	1477824969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENTRY EMERGENCY SQUAD, INC.

Provider Business Mailing Address
First Line	:	109 NORTH RD
Second Line	:
City	:	GREENE
State	:	NY
Zip	:	13778-2377
Country	:	US
Telephone Number	:	607-371-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 NORTH RD
Second Line	:
City	:	GREENE
State	:	NY
Zip	:	13778-2377
Country	:	US
Telephone Number	:	607-371-1141
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KYLE WEARNE
Credential	:
Telephone Number	:	607-371-1141

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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