Taconic Valley Ambulance Inc. – Land Ambulance

Key facts

NPI: 1194489153
Entity type: Organization (NPI type 2)
Primary specialty: Land Ambulance 3416L0300X
Legal business name: TACONIC VALLEY AMBULANCE INC.
Practice address: 17563 State Route 22
Berlin, NY 12022
Phone: (518) 410-8874
NPI assigned: Oct 26, 2021
Organization subpart: No

Authorized official

Name: Michael Church
Title: Captain
Phone: (518) 428-1055

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NY

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20220221000987	NY	Part B Supplier - Ambulance Service Supplier	0244624039	Practice locations: Berlin, NY

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Land Ambulance	3416L0300X			Yes

Addresses

Primary practice location

17563 State Route 22
Berlin, NY 12022

Mailing address

17563 State Route 22
Berlin, NY 12022

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 26, 2022.

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1194489153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17563 STATE ROUTE 22",
            "city": "BERLIN",
            "state": "NY",
            "postal_code": "12022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17563 STATE ROUTE 22",
            "city": "BERLIN",
            "state": "NY",
            "postal_code": "12022",
            "telephone_number": "518-410-8874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACONIC VALLEY AMBULANCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-01-15",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "518-428-1055"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, NY

All providers in Berlin, NY · Land Ambulance in New York

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.