Provider Demographics
NPI:1467903898
Name:FOOTHILLS MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:FOOTHILLS MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:315-777-5435
Mailing Address - Street 1:6458 E MARTINSBURG RD
Mailing Address - Street 2:LOT 2
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-4809
Mailing Address - Country:US
Mailing Address - Phone:315-777-5435
Mailing Address - Fax:
Practice Address - Street 1:6458 E MARTINSBURG RD
Practice Address - Street 2:LOT 2
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-4809
Practice Address - Country:US
Practice Address - Phone:315-777-5435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39486343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04159904Medicaid