Village of Minoa

Primary specialty

AmbulanceTaxonomy code 341600000X

License

12565 Issued in NY

Legal business name

VILLAGE OF MINOA

Doing business as

Minoa Ambulance

Practice address

240 N Main St
Minoa, NY 13116

Phone

(315) 656-3100

Fax

(315) 656-0825

NPI assigned

Mar 22, 2006

Last updated

Jul 30, 2024By 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

Lisa L Devona

Title

Village Clerk

Phone

(315) 656-3100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Minoa Ambulance Doing business as

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": "1142985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1730148107",
    "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": "240 N MAIN ST",
            "city": "MINOA",
            "state": "NY",
            "postal_code": "13116",
            "telephone_number": "315-656-3100",
            "fax_number": "315-656-0825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF MINOA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-22",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "DEVONA",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VILLAGE CLERK",
        "authorized_official_telephone_number": "315-656-3100"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NY",
            "license": "12565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590013295",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01955600",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minoa Ambulance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minoa Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin Louer, LMSW
• Minoa Nursing and Rehabilitation Center LLC (The Crossings Nursing and Rehabilitation Centre)
• Jessica Marie Serafin
• Deborah J. Sullivan-Witmer, CCC-SPLP
• Jackey Lynn Toombs, LPN
• Jenna Riley Wright

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.