Provider Demographics
NPI:1538188834
Name:OTISVILLE MT. HOPE VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:OTISVILLE MT. HOPE VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-386-9501
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10963-0196
Mailing Address - Country:US
Mailing Address - Phone:845-386-9501
Mailing Address - Fax:845-386-1244
Practice Address - Street 1:60 STATE STR
Practice Address - Street 2:
Practice Address - City:OTISVILLE
Practice Address - State:NY
Practice Address - Zip Code:10963
Practice Address - Country:US
Practice Address - Phone:845-386-9501
Practice Address - Fax:845-386-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360227Medicaid
NYA69911Medicare ID - Type Unspecified