Provider Demographics
NPI:1144306200
Name:MASSENA RESCUE SQUAD
Entity type:Organization
Organization Name:MASSENA RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ST.AMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-764-1999
Mailing Address - Street 1:341 E ORVIS ST
Mailing Address - Street 2:PO BOX 5314
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-3200
Mailing Address - Country:US
Mailing Address - Phone:315-764-1999
Mailing Address - Fax:315-769-7403
Practice Address - Street 1:341 E ORVIS ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-3200
Practice Address - Country:US
Practice Address - Phone:315-764-1999
Practice Address - Fax:315-769-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10191341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01975864Medicaid
NYBB6128Medicare ID - Type Unspecified