Provider Demographics
NPI:1720013329
Name:STILLWATER AMBULANCE FUND INC
Entity Type:Organization
Organization Name:STILLWATER AMBULANCE FUND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-664-8012
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:283 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:NY
Practice Address - Zip Code:12170
Practice Address - Country:US
Practice Address - Phone:518-664-8012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10630341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00060121OtherPALMETTO GBA RR MEDICARE
000407131001OtherBCBS OF NENY
10071542OtherCDPHP
394213OtherMVP
9727377OtherGHI
NY02382474Medicaid
NY02382474Medicaid