Provider Demographics
NPI:1700874658
Name:AUSABLE FORKS VOLUNTEER AMBULANCE SERVICE CORPORATION
Entity Type:Organization
Organization Name:AUSABLE FORKS VOLUNTEER AMBULANCE SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-647-8860
Mailing Address - Street 1:8020 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9704
Mailing Address - Country:US
Mailing Address - Phone:585-768-2192
Mailing Address - Fax:585-768-7323
Practice Address - Street 1:23 SCHOOL LANE
Practice Address - Street 2:
Practice Address - City:AUSABLE FORKS
Practice Address - State:NY
Practice Address - Zip Code:12912-0835
Practice Address - Country:US
Practice Address - Phone:518-647-8860
Practice Address - Fax:518-647-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15293416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01697474Medicaid
NY590011366OtherRAILROAD
NYBA1458Medicare PIN