Organization
GOUVERNEUR VOLUNTEER RESCUE SQUAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK A DEAVERS (DIRECTOR)
(315) 287-1321
Entity
Organization
Contact information
Practice address
1024 US HIGHWAY 11, GOUVERNEUR, NY 13642-3507
(315) 287-1321
(315) 287-3854
Mailing address
PO BOX 164, GOUVERNEUR, NY 13642-0164
(315) 287-1321
(315) 287-3954
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
05
—
02988094
—
NY
01
—
59008863
RAILROAD MEDICARE
—
Enumeration date
09/15/2014
Last updated
09/15/2014
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