Provider Demographics
NPI:1104001932
Name:NORTHERN AMBULANCE CORPS, LLC
Entity Type:Organization
Organization Name:NORTHERN AMBULANCE CORPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROCKHILL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:518-483-6650
Mailing Address - Street 1:347 ELM ST
Mailing Address - Street 2:PO BOX 607
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1500
Mailing Address - Country:US
Mailing Address - Phone:518-483-6659
Mailing Address - Fax:518-483-4440
Practice Address - Street 1:347 ELM ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1500
Practice Address - Country:US
Practice Address - Phone:518-483-6659
Practice Address - Fax:518-483-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02631950Medicaid
NY02631950Medicaid