MEDICARE: RAVENA 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	0468	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5900012637	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	:	1609866094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVENA RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	107 WASHINGTON AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12210-2231
Country	:	US
Telephone Number	:	888-603-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BRUNO BLVD
Second Line	:
City	:	RAVENA
State	:	NY
Zip	:	12143-1625
Country	:	US
Telephone Number	:	518-756-2096
Fax Number	:	518-756-6015

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MR. BRIAN DUNICAN
Credential	:
Telephone Number	:	888-603-2455

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/13/2019

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