Provider Demographics
NPI:1952378697
Name:SOUTH JEFFERSON RESCUE SQUAD INC
Entity Type:Organization
Organization Name:SOUTH JEFFERSON RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-768-2192
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 1:38 MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-1222
Practice Address - Country:US
Practice Address - Phone:585-768-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01083738Medicaid
NY01083738Medicaid