Waterford Rescue Squad Inc

Primary specialty

AmbulanceTaxonomy code 341600000X

License

10789 Issued in NY

Legal business name

WATERFORD RESCUE SQUAD INC

Practice address

46 4TH St
Waterford, NY 12188-2327

Phone

(518) 237-2473

Fax

(518) 235-0084

NPI assigned

Jul 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy Ann Weir

Title

Coo

Phone

(518) 237-2473

Specialties & licenses 1

Addresses

Other identifiers 4

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": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1629090576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 535",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130270535",
            "telephone_number": "315-635-1789",
            "fax_number": "315-635-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 4TH ST",
            "city": "WATERFORD",
            "state": "NY",
            "postal_code": "121882327",
            "telephone_number": "518-237-2473",
            "fax_number": "518-235-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD RESCUE SQUAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "WEIR",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "518-237-2473"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "10789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10019558",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "9602402",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01470364",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RR MEDICARE",
            "identifier": "590008498",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Smith
• Isabella Todd
• Nicole Ray Tychostup, RN
• Kelsey Lynn Vanvorst, LPN
• Sharon L Vyce
• Waterford-Halfmoon Ufsd
• Alexis Whalen
• Mary Elizabeth Zink, NY229435-1

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.