Skenesborough Emergency Squad Inc

Primary specialty

AmbulanceTaxonomy code 341600000X

License

10696 Issued in NY

Legal business name

SKENESBOROUGH EMERGENCY SQUAD INC

Practice address

37 Skenesborough Dr
Whitehall, NY 12887

Phone

(315) 499-2122

NPI assigned

Jul 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Brandon Paul Sparks

Title

Captain

Phone

(518) 499-2122

Specialties & licenses 1

Addresses

Other identifiers 5

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": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526169600000",
    "number": "1003845736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WASHINGTON AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122102231",
            "telephone_number": "888-603-2455",
            "fax_number": "888-603-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 SKENESBOROUGH DR",
            "city": "WHITEHALL",
            "state": "NY",
            "postal_code": "12887",
            "telephone_number": "315-499-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKENESBOROUGH EMERGENCY SQUAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2018-05-13",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "518-499-2122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "10696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO-RR MEDICARE",
            "identifier": "590009009",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "922835",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005602",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01522747",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NENY",
            "identifier": "000400552001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Monty, LADC
• Northeastern Ambulance Service LLC
• Ma Danica Paula Desabille Reyes, DPT
• Kathryn S. Riley, SLP
• Puja Sharma, MD
• Donna M Tipton, RN
• Whitehall Central School
• Whitehall Taxi Inc.

• All providers in Whitehall, NY
• Ambulance in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2018; 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.