Provider Demographics
NPI:1124150958
Name:TOWN OF HIGHLANDS AMBULANCE DISTRICT
Entity type:Organization
Organization Name:TOWN OF HIGHLANDS AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWN SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MERVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIVSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-446-4280
Mailing Address - Street 1:8610 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-204-3350
Mailing Address - Fax:716-247-5274
Practice Address - Street 1:254 MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND FALLS
Practice Address - State:NY
Practice Address - Zip Code:10928-1804
Practice Address - Country:US
Practice Address - Phone:845-446-4280
Practice Address - Fax:845-446-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3527341600000X
341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA09721Medicare ID - Type Unspecified