Provider Demographics
NPI:1871678722
Name:SMITH AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SMITH AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-852-6172
Mailing Address - Street 1:1659 CORTLAND STREET
Mailing Address - Street 2:
Mailing Address - City:DERUYTER
Mailing Address - State:NY
Mailing Address - Zip Code:13052
Mailing Address - Country:US
Mailing Address - Phone:315-852-6172
Mailing Address - Fax:
Practice Address - Street 1:1659 CORTLAND STREET
Practice Address - Street 2:
Practice Address - City:DERUYTER
Practice Address - State:NY
Practice Address - Zip Code:13052
Practice Address - Country:US
Practice Address - Phone:315-852-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00906881Medicaid
NY33932BMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID