Provider Demographics
NPI:1003845736
Name:SKENESBOROUGH EMERGENCY SQUAD INC
Entity Type:Organization
Organization Name:SKENESBOROUGH EMERGENCY SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-499-2122
Mailing Address - Street 1:107 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2231
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:888-603-2455
Practice Address - Street 1:37 SKENESBOROUGH DR
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:NY
Practice Address - Zip Code:12887
Practice Address - Country:US
Practice Address - Phone:315-499-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10696341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590009009OtherPALMETTO-RR MEDICARE
922835OtherMVP
VT1005602Medicaid
NY01522747Medicaid
000400552001OtherBCBS OF NENY
VT1005602Medicaid