Provider Demographics
NPI:1932508421
Name:ANDOVER VOLUNTEER AMBULANCE CORP INC
Entity Type:Organization
Organization Name:ANDOVER VOLUNTEER AMBULANCE CORP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-478-8361
Mailing Address - Street 1:60 S. MAIN STREET
Mailing Address - Street 2:P.O. BOX 726
Mailing Address - City:ANDOVER
Mailing Address - State:NY
Mailing Address - Zip Code:14806
Mailing Address - Country:US
Mailing Address - Phone:607-478-8361
Mailing Address - Fax:607-478-5003
Practice Address - Street 1:60 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NY
Practice Address - Zip Code:14806
Practice Address - Country:US
Practice Address - Phone:607-478-8361
Practice Address - Fax:607-478-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport