South Jefferson Rescue Squad Inc
Organization Active NPI Land Ambulance · Adams, NY
NPI 1952378697 · NPPES record last updated Feb 27, 2013
Key facts
- NPI
- 1952378697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 2226 (NY)
- Legal business name
- SOUTH JEFFERSON RESCUE SQUAD INC
- Practice address
- 38 Main St
Adams, NY 13605-1222 - Phone
- (585) 768-2192
- NPI assigned
- Mar 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Debbie Mabe
- Title
- President
- Phone
- (585) 768-2192
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2015732 | South Jefferson Rescue Squad Inc | 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 |
|---|---|---|---|---|
| O20051110000092 | NY | Part B Supplier - Ambulance Service Supplier | 7113945981 | Practice locations: Adams, NY |
National Provider Directory
Locations
38 Main St
Adams, NY 13605
Phone (315) 232-2624
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 2226 | NY | Yes |
Addresses
Primary practice location
38 Main St
Adams, NY 13605-1222
Mailing address
8020 E Main Rd
Le Roy, NY 14482-9704
Phone (585) 768-2192
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01083738 | Medicaid | NY |
Other providers in Adams, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2013. 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.