Provider Demographics
NPI:1295924272
Name:CEDARVILLE AMBULANCE INC.
Entity type:Organization
Organization Name:CEDARVILLE AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-822-5377
Mailing Address - Street 1:PO BOX 4066
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13504-4066
Mailing Address - Country:US
Mailing Address - Phone:315-724-6619
Mailing Address - Fax:315-797-2589
Practice Address - Street 1:960 STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-3908
Practice Address - Country:US
Practice Address - Phone:315-822-5377
Practice Address - Fax:315-822-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0832341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02984623Medicaid
NY02984623Medicaid