Provider Demographics
NPI:1508902800
Name:DURHAM AMBULANCE INC
Entity Type:Organization
Organization Name:DURHAM AMBULANCE INC
Other - Org Name:TOWN OF DURHAM VOLUNTEER AMBULANCE SQUAD INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:REAY
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-291-6335
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:NY
Mailing Address - Zip Code:12460
Mailing Address - Country:US
Mailing Address - Phone:518-239-6100
Mailing Address - Fax:518-239-6127
Practice Address - Street 1:1 MILKRUN ROAD
Practice Address - Street 2:
Practice Address - City:EAST DURHAM
Practice Address - State:NY
Practice Address - Zip Code:12423
Practice Address - Country:US
Practice Address - Phone:518-239-6100
Practice Address - Fax:518-239-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341600000X
NY19213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02499498Medicaid
NY02499498Medicaid
A52221Medicare PIN