Provider Demographics
NPI:1639132905
Name:MOHEGAN VOLUNTEER FIRE ASSOCIATION VOLUNTEER AMBULANCE CORPS INC
Entity type:Organization
Organization Name:MOHEGAN VOLUNTEER FIRE ASSOCIATION VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-526-1005
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 1:1975 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547
Practice Address - Country:US
Practice Address - Phone:914-526-1005
Practice Address - Fax:914-526-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10366341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01951275Medicaid
900951OtherMVP
590013205OtherRR MEDICARE
9634358OtherGHI
NY01951275Medicaid