Pound Ridge Lions Ambulance Corps
Organization Active NPI Ambulance · Pound Ridge, NY
NPI 1790861375 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1790861375
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 5954 (NY)
- Legal business name
- POUND RIDGE LIONS AMBULANCE CORPS
- Practice address
- 89 Westchester Ave
Pound Ridge, NY 10576-1702 - Phone
- (914) 764-4545
- Fax
- (914) 764-4545
- NPI assigned
- Oct 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Amiel Mark Peretz, EMT
- Title
- President
- Phone
- (914) 764-9055
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2176646 | Pound Ridge Lions Ambulance Corps | 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 |
|---|---|---|---|---|
| O20061104000008 | NY | Part B Supplier - Ambulance Service Supplier | 7719984772 | Practice locations: Pound Ridge, NY |
National Provider Directory
Locations
89 Westchester Ave
Pound Ridge, NY 10576
Phone (914) 764-4545
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 5954 | NY | Yes |
Addresses
Primary practice location
89 Westchester Ave
Pound Ridge, NY 10576-1702
Mailing address
89 Westchester Ave
P.O. Box 237
Pound Ridge, NY 10576-1702
Phone (914) 764-4545
Other providers in Pound Ridge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.