Provider Demographics
NPI:1154350841
Name:UPPER DELAWARE AMBULANCE CORPS INC
Entity type:Organization
Organization Name:UPPER DELAWARE AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KNACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-887-6070
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:26 KELLAM BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HANKINS
Practice Address - State:NY
Practice Address - Zip Code:12741-5002
Practice Address - Country:US
Practice Address - Phone:315-635-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10005341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
4190489OtherMVP
9611703OtherGHI
NY01812106Medicaid
590013548OtherPALMETTO GBA RR MEDICARE
NY01812106Medicaid