Provider Demographics
NPI:1043294614
Name:KUYAHOORA VOLUNTEER AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:KUYAHOORA VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:KUYAHOORA VALLEY AMBULANCE CORPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-826-3525
Mailing Address - Street 1:8610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7455
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-247-5274
Practice Address - Street 1:39 CASE STREET
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:NY
Practice Address - Zip Code:13431
Practice Address - Country:US
Practice Address - Phone:315-826-3525
Practice Address - Fax:315-826-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10230341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
9602732OtherGHI
NY01564089Medicaid
950957OtherMVP
590009493OtherPALMETTO GBA RAILROAD
NY55557BMedicare ID - Type Unspecified