Provider Demographics
NPI:1053318998
Name:UNION VOLUNTEER EMERGENCY SQUAD, INC.
Entity Type:Organization
Organization Name:UNION VOLUNTEER EMERGENCY SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-786-7502
Mailing Address - Street 1:PO BOX 8739
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13762-8739
Mailing Address - Country:US
Mailing Address - Phone:607-754-3414
Mailing Address - Fax:607-754-3657
Practice Address - Street 1:8 S. AVE B
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-754-3414
Practice Address - Fax:607-754-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10292341600000X
NY910483416L0300X
NY03313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01365324Medicaid
NY01365324Medicaid