Provider Demographics
NPI:1912058207
Name:HOOSIC VALLEY RESCUE SQUAD
Entity Type:Organization
Organization Name:HOOSIC VALLEY RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:518-753-6634
Mailing Address - Street 1:5530 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14201-3730
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-247-5274
Practice Address - Street 1:1448 NY ROUTE 40
Practice Address - Street 2:
Practice Address - City:SCHAGHTICOKE
Practice Address - State:NY
Practice Address - Zip Code:12154-0041
Practice Address - Country:US
Practice Address - Phone:518-753-6634
Practice Address - Fax:518-573-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4123341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01514525Medicaid
55220BMedicare PIN