Provider Demographics
NPI:1407873201
Name:TOWN OF LYONS
Entity Type:Organization
Organization Name:TOWN OF LYONS
Other - Org Name:TOWN OF LYONS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-651-5768
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:800-927-5845
Mailing Address - Fax:
Practice Address - Street 1:122 1/2 BROAD ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-1042
Practice Address - Country:US
Practice Address - Phone:315-946-6252
Practice Address - Fax:315-946-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105103416L0300X
NY342263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00908567Medicaid
NY00908567Medicaid