MEDICARE: MONTVILLE FIRE COMPANY 1 INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590008820	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	CT3753	OTHER	HEALTHNET
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	710C086B2CT01	OTHER	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1184619843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTVILLE FIRE COMPANY 1 INC

Provider Business Mailing Address
First Line	:	269 MAIN ST
Second Line	:
City	:	CROMWELL
State	:	CT
Zip	:	06416-2302
Country	:	US
Telephone Number	:	860-638-1800
Fax Number	:	860-638-1802

Provider Business Practice Location Address
First Line	:	77 ROUTE 163
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2117
Country	:	US
Telephone Number	:	860-848-8070
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANCE CHIEF
Name	:	RON TURNER
Credential	:
Telephone Number	:	860-848-8070

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	09/17/2010

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Directions to “MONTVILLE FIRE COMPANY 1 INC ” Practice Location

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