Lakeshore Volunteer Ambulance Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

1069 Issued in NY

Legal business name

LAKESHORE VOLUNTEER AMBULANCE INC

Practice address

5841 New Hartford St
Wolcott, NY 14590-1136

Phone

(315) 754-6489

Fax

(315) 754-8453

NPI assigned

Oct 26, 2005

Last updated

Jun 18, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. George Lockwood

Title

Director of Operations

Phone

(315) 594-9393

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1083604540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8020 E MAIN RD",
            "city": "LE ROY",
            "state": "NY",
            "postal_code": "144829704",
            "telephone_number": "585-768-2192",
            "fax_number": "585-768-7323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 NEW HARTFORD ST",
            "city": "WOLCOTT",
            "state": "NY",
            "postal_code": "145901136",
            "telephone_number": "315-754-6489",
            "fax_number": "315-754-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE VOLUNTEER AMBULANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "LOCKWOOD",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "315-594-9393",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NY",
            "license": "1069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02773224",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590012016",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kim M Jablonski, PT
• Christina Keim, LMHC
• April L Kellogg
• Ashley Kennedy
• Brunilda Kolaj, MD
• Casen Lange, RN
• Joella Lange
• Susan T. Lapp, BS
• Chantel Melanie Upson Lockwood, LCSW
• Charlotte L Lofgren, M.D.

• Land Ambulance in Wolcott, NY
• Providers in Wolcott, NY by specialty
• Land Ambulance in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.