MEDICARE: EAST WINDSOR AMBULANCE ASSOC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance		CT
2	3416L0300X	Land Ambulance	C047P1	CT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	590009265	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	104834400	OTHER	DEPT OF LABOR
3	777989	OTHER	CONNECTICARE

NPI Number	:	1114919305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST WINDSOR AMBULANCE ASSOC

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	EAST WINDSOR
State	:	CT
Zip	:	06088-0188
Country	:	US
Telephone Number	:	860-654-0515
Fax Number	:	860-623-5289

Provider Business Practice Location Address
First Line	:	25 SCHOOL ST
Second Line	:
City	:	EAST WINDSOR
State	:	CT
Zip	:	06088-9511
Country	:	US
Telephone Number	:	860-654-0515
Fax Number	:	860-623-5289

Authorized Official
Title or Position	:	AMBULANCE CHIEF
Name	:	MR. THOMAS J CLYNCH III
Credential	:
Telephone Number	:	860-654-0515

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/15/2012

8681 WINDSOR RD
WINDSOR, CA
95492-9511

Practice Phone: 707-687-7535
Practice Fax: