Provider Demographics
NPI:1578633939
Name:DIAZ MEMORIAL AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:DIAZ MEMORIAL AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER - PARAMEDIC
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:845-246-9097
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:P.O. BOX 147
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-1124
Mailing Address - Country:US
Mailing Address - Phone:845-246-9097
Mailing Address - Fax:845-246-9230
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-1124
Practice Address - Country:US
Practice Address - Phone:845-246-9097
Practice Address - Fax:845-246-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5514341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00406693Medicaid
NY922808OtherMVP HEALTH PLAN
NY00406693Medicaid
A01541Medicare PIN