Basic Information
| Provider Information | |||||||||
| NPI: | 1144215534 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLESVILLE VOLUNTEER AMBULANCE SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 GATES RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | VESTAL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138502288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077728794 | ||||||||
| FaxNumber: | 6077721223 | ||||||||
| Practice Location | |||||||||
| Address1: | MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HARPURSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6076931099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 08/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | KNAPP | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6076931099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 01767179 | 05 | NY | MEDICAID |