Provider Demographics
NPI:1194722124
Name:COOPERSTOWN MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:COOPERSTOWN MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCGOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-433-0000
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0202
Mailing Address - Country:US
Mailing Address - Phone:607-547-5637
Mailing Address - Fax:607-547-4107
Practice Address - Street 1:81 AVERILL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1001
Practice Address - Country:US
Practice Address - Phone:607-547-5637
Practice Address - Fax:607-547-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00926930Medicaid
NY38262BMedicare PIN
GA590009151Medicare PIN
GA590013019Medicare PIN
NY00926930Medicaid
NYA02252Medicare PIN