Provider Demographics
NPI:1720018807
Name:WESTERN AREA VOLUNTEER EMERGENCY SERVICE INC
Entity Type:Organization
Organization Name:WESTERN AREA VOLUNTEER EMERGENCY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-487-1212
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 1:202 BENNETT RD
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1593
Practice Address - Country:US
Practice Address - Phone:315-487-1212
Practice Address - Fax:315-487-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10268341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590009862OtherPALMETTO RR MEDICARE
355498600OtherUS DEPT OF LABOR OWCP
9611713OtherGHI
NY01597855Medicaid
953060OtherMVP
NY55638BMedicare ID - Type Unspecified