Provider Demographics
NPI:1912079286
Name:LAFAYETTE AMBULANCE DEPARTMENT INC.
Entity Type:Organization
Organization Name:LAFAYETTE AMBULANCE DEPARTMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-677-3400
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:800-927-5845
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:2444 RTE 11 SOUTH
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084
Practice Address - Country:US
Practice Address - Phone:315-677-3400
Practice Address - Fax:315-677-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0401341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01273770Medicaid
NYBA1290Medicare PIN