Provider Demographics
NPI:1205823085
Name:COLRAIN VOL AMB ASSOC, INC
Entity Type:Organization
Organization Name:COLRAIN VOL AMB ASSOC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-624-0128
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:978-356-2721
Practice Address - Street 1:51 MAIN RD
Practice Address - Street 2:
Practice Address - City:COLRAIN
Practice Address - State:MA
Practice Address - Zip Code:01340-5501
Practice Address - Country:US
Practice Address - Phone:413-624-5528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3369341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
807136OtherTUFTS HEALTH PLAN
000000027770OtherBMC HEALTHNET PLAN
MA076259OtherBLUE CROSS BLUE SHEILD
590012303OtherRR MEDICARE
042349458OtherTRICARE
MA1715585Medicaid
MH1050OtherHARVARD PILGRIM
042349458OtherTRICARE