MEDICARE: NORTH GREENBUSH AMBULANCE ASSOCIATION 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
2	3416L0300X	Land Ambulance

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	:	1710977285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH GREENBUSH AMBULANCE ASSOCIATION INC

Provider Business Mailing Address
First Line	:	5530 SHERIDAN DR
Second Line	:	SUITE 3B
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-3730
Country	:	US
Telephone Number	:	716-204-3350
Fax Number	:	716-634-7670

Provider Business Practice Location Address
First Line	:	409 MAIN AVE
Second Line	:
City	:	WYNANTSKILL
State	:	NY
Zip	:	12198-8219
Country	:	US
Telephone Number	:	518-283-5511
Fax Number	:	518-283-7781

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHLEEN ALLEN
Credential	:
Telephone Number	:	518-283-5511

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	06/30/2016

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