Provider Demographics
NPI:1639844301
Name:MIDDLESEX VALLEY VOLUNTEER AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:MIDDLESEX VALLEY VOLUNTEER AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-554-6657
Mailing Address - Street 1:8610 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7455
Mailing Address - Country:US
Mailing Address - Phone:716-704-3350
Mailing Address - Fax:713-247-5274
Practice Address - Street 1:817 STATE ROUTE 245
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NY
Practice Address - Zip Code:14507
Practice Address - Country:US
Practice Address - Phone:585-554-6657
Practice Address - Fax:585-554-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416S0300XTransportation ServicesAmbulanceWater Transport