Provider Demographics
NPI:1386932614
Name:MID-COUNTY VOLUNTEER AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:MID-COUNTY VOLUNTEER AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:F
Authorized Official - Last Name:LACOMB
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT-P
Authorized Official - Phone:518-673-2039
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:PALATINE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13428-0453
Mailing Address - Country:US
Mailing Address - Phone:518-673-2039
Mailing Address - Fax:518-673-3106
Practice Address - Street 1:46 WEST GRAND STREET
Practice Address - Street 2:
Practice Address - City:PALATINE BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13428
Practice Address - Country:US
Practice Address - Phone:518-673-2039
Practice Address - Fax:518-673-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2813341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance