Provider Demographics
NPI:1427031319
Name:FORT EDWARD RESCUE SQUAD INC
Entity Type:Organization
Organization Name:FORT EDWARD RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-747-6198
Mailing Address - Street 1:5530 SHERIDAN DR
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3730
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-634-7170
Practice Address - Street 1:75 SCHUYLER STREET
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828
Practice Address - Country:US
Practice Address - Phone:518-747-6198
Practice Address - Fax:518-746-9479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09742341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
000400562001OtherBS OF NORTHEASTERN NY
NY01767055Medicaid
9718591OtherGHI
590011143OtherPALMETTO GBA RAILROAD
10023189OtherCDPHP
958571OtherMVP
NY01767055Medicaid