Provider Demographics
NPI:1821530544
Name:RIVERSIDE PARK EMS
Entity Type:Organization
Organization Name:RIVERSIDE PARK EMS
Other - Org Name:SIX FLAGS EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:ALS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:413-786-9300
Mailing Address - Street 1:1623 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2512
Mailing Address - Country:US
Mailing Address - Phone:413-786-9300
Mailing Address - Fax:413-786-6324
Practice Address - Street 1:1623 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2512
Practice Address - Country:US
Practice Address - Phone:413-786-9300
Practice Address - Fax:413-786-6324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIX FLAGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3985341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance