Coventry Emergency Squad, Inc.
Organization Active NPI Land Ambulance · Greene, NY
NPI 1477824969 · NPPES record last updated Jan 16, 2012
Key facts
- NPI
- 1477824969
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 30300 (NY)
- Legal business name
- COVENTRY EMERGENCY SQUAD, INC.
- Practice address
- 109 North Rd
Greene, NY 13778-2377 - Phone
- (607) 371-1141
- NPI assigned
- Jan 16, 2012
- Organization subpart
- No
Authorized official
- Name
- Kyle Wearne
- Title
- President
- Phone
- (607) 371-1141
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2307533 | Coventry Emergency Squad Inc | Certificate of waiver | Mar 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120504000163 | NY | Part B Supplier - Ambulance Service Supplier | 4587826755 | Practice locations: Greene, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 30300 | NY | Yes |
Addresses
Primary practice location
109 North Rd
Greene, NY 13778-2377
Mailing address
109 North Rd
Greene, NY 13778-2377
Phone (607) 371-1141
Other providers in Greene, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2012. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.