Provider Demographics
NPI:1447226378
Name:PROSPECT VOLUNTEER AMBULANCE, INC.
Entity Type:Organization
Organization Name:PROSPECT VOLUNTEER AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-768-2192
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-0186
Mailing Address - Country:US
Mailing Address - Phone:585-768-2192
Mailing Address - Fax:585-768-7323
Practice Address - Street 1:915 TRENTON FALLS ST.
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:NY
Practice Address - Zip Code:13435
Practice Address - Country:US
Practice Address - Phone:585-768-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01767197Medicaid
NY01767197Medicaid