Gouverneur Volunteer Rescue Squad Inc

Primary specialty

AmbulanceTaxonomy code 341600000X

License

4417 Issued in NY

Legal business name

GOUVERNEUR VOLUNTEER RESCUE SQUAD INC

Practice address

1024 US Highway 11
Gouverneur, NY 13642-3507

Phone

(315) 287-1321

Fax

(315) 287-3954

NPI assigned

Oct 10, 2005

Last updated

Jan 6, 2015By 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. Mark Deavers

Title

Director of Operations

Phone

(315) 287-1321

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1245228782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 NEW CASTLE RD",
            "city": "SLIPPERY ROCK",
            "state": "PA",
            "postal_code": "160574228",
            "telephone_number": "800-280-5974",
            "fax_number": "724-794-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 US HIGHWAY 11",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136423507",
            "telephone_number": "315-287-1321",
            "fax_number": "315-287-3954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOUVERNEUR VOLUNTEER RESCUE SQUAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "DEAVERS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "315-287-1321",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "4417",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NY",
            "license": "43946",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NON-MEDICAL MEDICAID PROVIDER NUMBER",
            "identifier": "02988094",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590008863",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01640344",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gouverneur Hospital
• Gouverneur Hospital
• Gouverneur Nursing Home Company Inc. (Kinney Nursing Home)
• Gouverneur Pediatrics,PC
• Gouverneur Physical Therapy, PLLC
• Gouverneur Volunteer Rescue Squad Inc
• Jennifer Grant, RPH
• Bruce John Grattan Jr., DO, MS, RD
• James Grenier, PHARM D
• Teah Lee Griffith

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; 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.