MEDICARE: SOUTHERN OSWEGO VOLUNTEER AMBULANCE CORPS 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	10751	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590009245	OTHER		PALMETTO GBA RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	990578	OTHER	MVP
4	147439FY	OTHER	PREFERRED CARE

General Provider Information

NPI Number	:	1902848799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN OSWEGO VOLUNTEER AMBULANCE CORPS 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	:	315-635-3289

Provider Business Practice Location Address
First Line	:	8 GERTRUDE DR
Second Line	:
City	:	CENTRAL SQUARE
State	:	NY
Zip	:	13036-2600
Country	:	US
Telephone Number	:	315-676-5071
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL MONTGOMERY JR.
Credential	:
Telephone Number	:	315-676-5071

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	12/12/2011

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Directions to “SOUTHERN OSWEGO VOLUNTEER AMBULANCE CORPS INC ” Practice Location

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