Provider Demographics
NPI:1508813726
Name:NORTH WARREN EMERGENCY SQUAD INC
Entity Type:Organization
Organization Name:NORTH WARREN EMERGENCY SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAVERGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-494-4317
Mailing Address - Street 1:107 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2200
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:888-603-2455
Practice Address - Street 1:2 COUGAR LANE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:NY
Practice Address - Zip Code:12817
Practice Address - Country:US
Practice Address - Phone:518-494-4317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10301341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
959849OtherGHI
959849OtherMVP
10027480OtherCDPHP
NY01807390Medicaid
590012180OtherPAIMETTO GBA
10027480OtherCDPHP