Provider Demographics
NPI:1326144072
Name:WARRENSBURG EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:WARRENSBURG EMERGENCY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-623-4911
Mailing Address - Street 1:107 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2231
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:888-603-2455
Practice Address - Street 1:3 KING ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:NY
Practice Address - Zip Code:12885
Practice Address - Country:US
Practice Address - Phone:518-623-4911
Practice Address - Fax:518-623-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10557341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
000400847000OtherBS OF NENY
10039586OtherCDPHP
9602117OtherGHI
NY02040751Medicaid
10039586OtherCDPHP