Provider Demographics
NPI:1831285410
Name:CORNING AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:CORNING AMBULANCE SERVICE INC
Other - Org Name:AMR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0296
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:25 E PULTENEY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2208
Practice Address - Country:US
Practice Address - Phone:607-936-4170
Practice Address - Fax:607-937-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
NY316603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831285410OtherTRICARE EAST
NY00358241Medicaid
PA001235398Medicaid
NY590010917OtherRR MEDICARE