Provider Demographics
NPI:1235129701
Name:LAKE PLACID VOLUNTEER AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:LAKE PLACID VOLUNTEER AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:518-523-8052
Mailing Address - Street 1:107 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2200
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:888-603-2455
Practice Address - Street 1:388 MILL POND DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946
Practice Address - Country:US
Practice Address - Phone:518-523-9512
Practice Address - Fax:518-523-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1530341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01606055Medicaid
590009114OtherRAILROAD MEDICARE
590009114OtherRAILROAD MEDICARE