Provider Demographics
NPI:1356377964
Name:NORTH SENECA AMBULANCE INC
Entity type:Organization
Organization Name:NORTH SENECA AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTFOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-539-5002
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:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:1645 NORTH RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-9447
Practice Address - Country:US
Practice Address - Phone:315-539-5386
Practice Address - Fax:315-539-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
9708738OtherGHI
NY00450422Medicaid
441590098OtherPALMETTO GBA
NY14993BMedicare ID - Type Unspecified