Provider Demographics
NPI:1710975180
Name:RICHMONDVILLE VOLUNTEER EMERGENCY SQUAD INC
Entity Type:Organization
Organization Name:RICHMONDVILLE VOLUNTEER EMERGENCY SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-257-7080
Mailing Address - Street 1:PO BOX 290184
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0184
Mailing Address - Country:US
Mailing Address - Phone:800-452-8191
Mailing Address - Fax:860-721-6362
Practice Address - Street 1:388 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICHMONDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12149-0011
Practice Address - Country:US
Practice Address - Phone:518-294-8888
Practice Address - Fax:601-538-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4726341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590008812OtherRAILROAD MEDICARE
NY01297447Medicaid
590008812OtherRAILROAD MEDICARE