Taconic Valley Ambulance Inc.

Primary specialty

Land AmbulanceTaxonomy code 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

Last updated

May 26, 2022By 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

Michael Church

Title

Captain

Phone

(518) 428-1055

Specialties & licenses 1

Addresses

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": "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": []
}

• Liane Densmore, OTA
• Hilary R Ferris, COTA
• Stephanie Michelle Hover, O.T.R./L.
• Jennifer Lopez, MD
• Ellen Marie Olson, OTR/L
• Town of Berlin
• Angelina Maria Wasielewski, OTR/L

• Land Ambulance in Berlin, NY
• Providers in Berlin, 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 May 26, 2022; 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.