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Organization

GOUVERNEUR VOLUNTEER RESCUE SQUAD INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MARK DEAVERS (DIRECTOR OF OPERATIONS)
(315) 287-1321
Entity
Organization

Contact information

Practice address
1024 US HIGHWAY 11, GOUVERNEUR, NY 13642-3507
(315) 287-1321
(315) 287-3954
Mailing address
892 NEW CASTLE RD, SLIPPERY ROCK, PA 16057-4228
(800) 280-5974
(724) 794-1633

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
4417
NY
343900000X
Non-emergency Medical Transport (VAN)
43946
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01640344
NY
01
02988094
NON-MEDICAL MEDICAID PROVIDER NUMBER
NY
01
590008863
RAILROAD MEDICARE
Enumeration date
10/10/2005
Last updated
01/06/2015
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