MEDICARE: HADDAM VOLUNTEER AMBULANCE SERVICE 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	341600000X	Ambulance	C061B1	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590010909	OTHER	CT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205826765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HADDAM VOLUNTEER AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	PO BOX 290184
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06129-0184
Country	:	US
Telephone Number	:	860-257-9201
Fax Number	:	860-721-6362

Provider Business Practice Location Address
First Line	:	9 SKINNER RD
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-4314
Country	:	US
Telephone Number	:	860-345-2500
Fax Number	:	860-345-2725

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MS. MARY T GENTILE
Credential	:
Telephone Number	:	860-257-9201

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	01/15/2009

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Directions to “HADDAM VOLUNTEER AMBULANCE SERVICE INC ” Practice Location

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