Potsdam Volunteer Rescue Squad Inc

Primary specialty

AmbulanceTaxonomy code 341600000X

License

4426 Issued in NY

Legal business name

POTSDAM VOLUNTEER RESCUE SQUAD INC

Practice address

29 Elm St
Potsdam, NY 13676-1965

Phone

(315) 265-2550

Fax

(315) 265-6859

NPI assigned

Oct 26, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary T Gentile

Title

Authorized Agent

Phone

(860) 257-9201

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1003806563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290184",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061290184",
            "telephone_number": "860-257-9201",
            "fax_number": "860-721-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 ELM ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761965",
            "telephone_number": "315-265-2550",
            "fax_number": "315-265-6859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTSDAM VOLUNTEER RESCUE SQUAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "GENTILE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "860-257-9201",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "4426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590009942",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01629547",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Pitts, RN
• Michael Thomas Pitts, ATC
• Jennifer Lynn Polniak, LMHC
• Potsdam Birth House LLC
• Potsdam Central School District
• Keith Allen Powell, PA
• Michael William Pratt, BS
• Precision Draws
• Priti V Mandalaywala MD
• Private Healthcare Facilities

• Ambulance in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Ambulance in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.