Provider Demographics
NPI:1205267523
Name:SODUS TOWN AMBULANCE CORPS
Entity type:Organization
Organization Name:SODUS TOWN AMBULANCE CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-483-6531
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:800-927-5845
Mailing Address - Fax:
Practice Address - Street 1:5496 BRICK SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROSE
Practice Address - State:NY
Practice Address - Zip Code:14516-9765
Practice Address - Country:US
Practice Address - Phone:315-706-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04020893Medicaid
P01469936OtherRAILROAD MEDICARE