Provider Demographics
NPI:1346227683
Name:GREATER BALDWINSVILLE AMBULANCE CORP INC
Entity Type:Organization
Organization Name:GREATER BALDWINSVILLE AMBULANCE CORP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCOPIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-638-4328
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 ALBERT PALMER LN
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2401
Practice Address - Country:US
Practice Address - Phone:315-638-4328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10475341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1371186Medicaid
3200259OtherGHI
951017OtherMVP
59007883OtherPALMETTO GBA RAILROAD
NY1371186Medicaid