Provider Demographics
NPI:1215979760
Name:SLOATSBURG COMMUNITY AMBULANCE CORPS, INC
Entity type:Organization
Organization Name:SLOATSBURG COMMUNITY AMBULANCE CORPS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-753-2445
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-0527
Mailing Address - Country:US
Mailing Address - Phone:610-401-2041
Mailing Address - Fax:610-401-2100
Practice Address - Street 1:62 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SLOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10974-1718
Practice Address - Country:US
Practice Address - Phone:845-753-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01439936Medicaid
NY01439936Medicaid