Provider Demographics
NPI:1003833617
Name:PUTNAM VALLEY VOLUNTEER AMBULANCE CORPORATIONS INC
Entity Type:Organization
Organization Name:PUTNAM VALLEY VOLUNTEER AMBULANCE CORPORATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-526-3119
Mailing Address - Street 1:5530 SHERIDAN DR STE 3B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3730
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-634-7870
Practice Address - Street 1:218 OSCAWANA LAKE ROAD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579
Practice Address - Country:US
Practice Address - Phone:845-526-3119
Practice Address - Fax:845-526-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10564341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590010010OtherPALMETTO RR MEDICARE
NY01644086Medicaid
9599740OtherGHI
NY01644086Medicaid