Provider Demographics
NPI:1336114982
Name:VILLAGE AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:VILLAGE AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:413-458-4889
Mailing Address - Street 1:107 WASHINGTON AVE
Mailing Address - Street 2:VILLAGE AMBULANCE C/O FASNY CREDIT UNION
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2200
Mailing Address - Country:US
Mailing Address - Phone:413-458-4889
Mailing Address - Fax:413-458-8476
Practice Address - Street 1:30 WATER ST.
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-4889
Practice Address - Fax:413-458-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3894341600000X, 3416L0300X
VT12053416L0300X, 343900000X
MA1234343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA040459OtherBLUE CROSS BLUE SHIELD
MA1709593Medicaid
756911OtherCONNECTICARE
610774700OtherDEPARTMENT OF LABOR
803149OtherTUFTS HEALTH PLAN
MA0783OtherHEALTH NET
NY00774456Medicaid
MA110030922AMedicaid
VT1000568Medicaid
000000024911OtherBMC HEALTHNET PLAN
701581OtherHARVARD PILGRIM
A1071632OtherOXFORD
MA110030922AMedicaid