MEDICARE: SPENCERPORT VOLUNTEER AMBULANCE SERVICE 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	2735	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
2	PSPENCERPAM	OTHER	NY	MONROE PLAN

General Provider Information

NPI Number	:	1689640559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPENCERPORT VOLUNTEER AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	8020 E MAIN RD
Second Line	:
City	:	LE ROY
State	:	NY
Zip	:	14482-9704
Country	:	US
Telephone Number	:	585-768-2192
Fax Number	:	585-768-7323

Provider Business Practice Location Address
First Line	:	116 LYELL AVE
Second Line	:
City	:	SPENCERPORT
State	:	NY
Zip	:	14559-1812
Country	:	US
Telephone Number	:	585-768-2192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIE TEWKSBURY
Credential	:
Telephone Number	:	585-768-2192

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	02/27/2013

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