MEDICARE: CENTRAL ONEIDA COUNTY VOLUNTEER AMBULANCE CORPS.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	955362	OTHER	NY	MOHAWH VALLEY PHYSICAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659316669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL ONEIDA COUNTY VOLUNTEER AMBULANCE CORPS.

Provider Business Mailing Address
First Line	:	892 NEW CASTLE RD
Second Line	:
City	:	SLIPPERY ROCK
State	:	PA
Zip	:	16057-4228
Country	:	US
Telephone Number	:	800-280-5974
Fax Number	:	724-794-1633

Provider Business Practice Location Address
First Line	:	7489 E SOUTH ST
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-3718
Country	:	US
Telephone Number	:	315-853-2118
Fax Number	:	315-853-2611

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DEAN DZWONKAS
Credential	:
Telephone Number	:	315-853-2118

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	01/23/2017

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