Provider Demographics
NPI:1073557849
Name:CASTLETON VOLUNTEER AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:CASTLETON VOLUNTEER AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-421-6171
Mailing Address - Street 1:8610 MAIN STREET
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 1:1700 BROOKVIEW ROAD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9702
Practice Address - Country:US
Practice Address - Phone:518-732-2563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01750898Medicaid
NY01750898Medicaid