Ravena Rescue Squad Inc

Primary specialty

AmbulanceTaxonomy code 341600000X

License

0468 Issued in NY

Legal business name

RAVENA RESCUE SQUAD INC

Practice address

1 Bruno Blvd
Ravena, NY 12143-1625

Phone

(518) 756-2096

Fax

(518) 756-6015

NPI assigned

Oct 26, 2005

Last updated

Aug 13, 2019By 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. Brian Dunican

Title

Authorized Agent

Phone

(888) 603-2455

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1609866094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WASHINGTON AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122102231",
            "telephone_number": "888-603-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRUNO BLVD",
            "city": "RAVENA",
            "state": "NY",
            "postal_code": "121431625",
            "telephone_number": "518-756-2096",
            "fax_number": "518-756-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVENA RESCUE SQUAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "DUNICAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "888-603-2455",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "0468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "5900012637",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01903488",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea M. Persico, M.S.ED.
• Jamie L Philpott
• Marybeth Pierrot
• Tina Marie Racine, COTA/L
• Karen Randio
• Kathleen Carol Rice
• Kara Jayne Risley
• Rite Aid of New York Inc (Rite Aid Pharmacy 04805)
• Dorothea Roberts
• Meagan Rose, LMSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.