Provider Demographics
NPI:1235129628
Name:JOHNSTOWN AREA VOLUNTEER AMBULANCE CORPS, INC.
Entity Type:Organization
Organization Name:JOHNSTOWN AREA VOLUNTEER AMBULANCE CORPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASZKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-762-9120
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0429
Mailing Address - Country:US
Mailing Address - Phone:518-235-7670
Mailing Address - Fax:518-235-7601
Practice Address - Street 1:231 N PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-1216
Practice Address - Country:US
Practice Address - Phone:518-762-9120
Practice Address - Fax:518-736-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1713341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590011684OtherRAILROAD MEDICARE
NY01534610Medicaid
590011684OtherRAILROAD MEDICARE