Black River Ambulance Squad, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

2232 Issued in NY

Legal business name

BLACK RIVER AMBULANCE SQUAD, INC

Practice address

121 Leray St
Black River, NY 13612-2114

Phone

(315) 773-4501

Fax

(315) 775-0291

NPI assigned

Jul 30, 2007

Last updated

Jul 30, 2007By 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

Mr. Alan Claude Gaines

Title

Billing Officer

Phone

(315) 773-4501

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1972793602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 LERAY ST",
            "address_2": "PO BOX 314",
            "city": "BLACK RIVER",
            "state": "NY",
            "postal_code": "136122114",
            "telephone_number": "315-773-4501",
            "fax_number": "315-775-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 LERAY ST",
            "city": "BLACK RIVER",
            "state": "NY",
            "postal_code": "136122114",
            "telephone_number": "315-773-4501",
            "fax_number": "315-775-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER AMBULANCE SQUAD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "CLAUDE",
        "authorized_official_title_or_position": "BILLING OFFICER",
        "authorized_official_telephone_number": "315-773-4501",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NY",
            "license": "2232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01793580",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Black River Dental PLLC
• Vincent Anthony Cesario Jr., D.M.D.
• Robert Paul Edgar, LPN
• April Eldridge
• Elizabeth Leigh Elmer, MS

• Land Ambulance in Black River, NY
• Providers in Black River, NY by specialty
• Land Ambulance in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; 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.