Provider Demographics
NPI:1306862867
Name:THOUSAND ISLANDS EMERGENCY RESCUE SERVICE INC
Entity Type:Organization
Organization Name:THOUSAND ISLANDS EMERGENCY RESCUE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-686-4333
Mailing Address - Street 1:8020 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9704
Mailing Address - Country:US
Mailing Address - Phone:585-768-2192
Mailing Address - Fax:585-768-7323
Practice Address - Street 1:100 UNION STREET
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-9998
Practice Address - Country:US
Practice Address - Phone:315-686-4333
Practice Address - Fax:315-686-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10174341600000X
NY07413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672264Medicaid
P00274166OtherPALMETTO GBA RR MEDICARE
BA0471Medicare UPIN