MEDICARE: BALLSTON LAKE EMERGENCY 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	10039720	OTHER	CDPHP
2	324527	OTHER	MVP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	590014655	OTHER	PALMETTO GBA

General Provider Information

NPI Number	:	1821074840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALLSTON LAKE EMERGENCY SQUAD INC

Provider Business Mailing Address
First Line	:	PO BOX 535
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-0535
Country	:	US
Telephone Number	:	315-635-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123 RT 146A
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019
Country	:	US
Telephone Number	:	516-399-7066
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN BOYD
Credential	:
Telephone Number	:	518-399-7066

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	11/27/2024

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