Provider Demographics
NPI:1114021219
Name:NORTH QUEENSBURY VOLUNTEER RESCUE SQUAD INC
Entity Type:Organization
Organization Name:NORTH QUEENSBURY VOLUNTEER RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-603-2455
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0676
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:518-391-2601
Practice Address - Street 1:ROUTE 9 BOX 272
Practice Address - Street 2:
Practice Address - City:CLEVERDALE
Practice Address - State:NY
Practice Address - Zip Code:12820
Practice Address - Country:US
Practice Address - Phone:518-656-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02654171Medicaid
NY02654171Medicaid