Granville Rescue Squad, Inc.
Organization Active NPI Ambulance · Granville, NY
NPI 1679550990 · NPPES record last updated Dec 15, 2025
Key facts
- NPI
- 1679550990
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 10046 (NY)
- Legal business name
- GRANVILLE RESCUE SQUAD, INC.
- Practice address
- 52 E Potter Ave
Granville, NY 12832-1620 - Phone
- (518) 642-1830
- Fax
- (315) 635-3289
- NPI assigned
- Dec 28, 2005
- Organization subpart
- No
Authorized official
- Name
- Michael Zinn
- Title
- Assistant Captain
- Phone
- (518) 642-1830
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2304367 | Granville Rescue Squad | 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 |
|---|---|---|---|---|
| O20091007000265 | NY | Part B Supplier - Ambulance Service Supplier | 0042356958 | Practice locations: Granville, NY |
National Provider Directory
Locations
52 E Potter Ave
Granville, NY 12832
Phone (518) 642-1830
79 North St
Granville, NY 12832
Phone (518) 642-0612
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 10046 | NY | Yes |
Addresses
Primary practice location
52 E Potter Ave
Granville, NY 12832-1620
Mailing address
PO Box 535
Baldwinsville, NY 13027-0535
Phone (315) 635-1789
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999535 | Other | MVP | |
| 10026607 | Other | CDPHP | |
| 01693989 | Medicaid | NY | |
| 00040013100 | Other | BS OF NORTHEASTERN NY | |
| 9624705 | Other | GHI | |
| 590011367 | Other | PALMETTO GBA RAILROAD | |
| 1006297 | Other | VT EDS |
Other providers in Granville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2025. 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.