Provider Demographics
NPI:1093782922
Name:SOUTHEAST QUADRANT MOBILE CRITICAL CARE UNIT INC
Entity type:Organization
Organization Name:SOUTHEAST QUADRANT MOBILE CRITICAL CARE UNIT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-218-0026
Mailing Address - Street 1:5530 SHERIDAN DR
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3730
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-634-7170
Practice Address - Street 1:25247 BAIRD ROAD
Practice Address - Street 2:
Practice Address - City:PENFILED
Practice Address - State:NY
Practice Address - Zip Code:14526-2332
Practice Address - Country:US
Practice Address - Phone:585-218-0025
Practice Address - Fax:585-218-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27973416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPSEQUADMOBILOtherMONROE PLAN
NY590015041OtherMEDICARE RAILROAD
NYDD0441Medicare ID - Type Unspecified