Provider Demographics
NPI:1942290408
Name:NATURAL BRIDGE VOLUNTEER AMBULANCE, INC.
Entity Type:Organization
Organization Name:NATURAL BRIDGE VOLUNTEER AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-644-9898
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:27570 HIGH STREET
Mailing Address - City:NATURAL BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13665
Mailing Address - Country:US
Mailing Address - Phone:315-644-9898
Mailing Address - Fax:315-644-4444
Practice Address - Street 1:2750 HIGH STREET
Practice Address - Street 2:
Practice Address - City:NATURAL BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13665-1111
Practice Address - Country:US
Practice Address - Phone:315-644-9898
Practice Address - Fax:315-644-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2017-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0722341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684100Medicaid
NYP00076396OtherRAILROAD MEDICARE
NYP00076396OtherRAILROAD MEDICARE