Organization
PHILMONT RESCUE SQUAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICK E TRACEY JR. CCRN EMT (ADMINISTRATOR CAPTAIN)
(518) 672-6192
Entity
Organization
Contact information
Practice address
4 MAPLE AVE, PHILMONT, NY 12565
(518) 672-7401
Mailing address
PO BOX 535, BALDWINSVILLE, NY 13027
(315) 635-1789
(315) 635-3289
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
10443
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000402311001
BCBS OF NENY
—
05
—
01519171
—
NY
01
—
10020076
CDPHP
—
01
—
356921
MVP
—
01
—
A2348847
OXFORD
—
Enumeration date
07/03/2006
Last updated
08/22/2020
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