Provider Demographics
NPI:1689763583
Name:ORISKANY FALLS VOLUNTEER AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:ORISKANY FALLS VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-821-3387
Mailing Address - Street 1:PO BOX 4066
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13504-4066
Mailing Address - Country:US
Mailing Address - Phone:315-724-6619
Mailing Address - Fax:315-797-2589
Practice Address - Street 1:172 MADISON STREET
Practice Address - Street 2:
Practice Address - City:ORISKANY FALLS
Practice Address - State:NY
Practice Address - Zip Code:13425
Practice Address - Country:US
Practice Address - Phone:315-821-6171
Practice Address - Fax:315-821-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02757459Medicaid
NYBA0491Medicare ID - Type Unspecified