Provider Demographics
NPI:1528018066
Name:FIVE COUNTIES AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:FIVE COUNTIES AMBULANCE SERVICE INC
Other - Org Name:AMERICAN MEDICAL RESPONSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-495-1220
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1160 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2245
Practice Address - Country:US
Practice Address - Phone:613-218-4070
Practice Address - Fax:613-218-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01864048Medicaid
NY1000023985OtherNY WORKERS COMP
NY1000023985OtherNY WORKERS COMP
NY01864048Medicaid
NYA59491Medicare PIN