MEDICARE: SAND LAKE AMBULANCE, 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	12260	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	:	1629182076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAND LAKE AMBULANCE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 787
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-0787
Country	:	US
Telephone Number	:	888-603-2455
Fax Number	:	518-674-1096

Provider Business Practice Location Address
First Line	:	3643 NY ROUTE 43
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196
Country	:	US
Telephone Number	:	518-674-2221
Fax Number	:	518-674-1096

Authorized Official
Title or Position	:	OPPERATIONS MANAGER
Name	:	MR. HAMISH C MCMILLAN
Credential	:
Telephone Number	:	888-603-2455

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	05/22/2023

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