MEDICARE: TOWN OF TOLLAND

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	C142B1	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590014253	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1871581264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF TOLLAND

Provider Business Mailing Address
First Line	:	PO BOX 290184
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06129-0184
Country	:	US
Telephone Number	:	800-452-8191
Fax Number	:	860-563-3403

Provider Business Practice Location Address
First Line	:	21 TOLLAND GRN
Second Line	:
City	:	TOLLAND
State	:	CT
Zip	:	06084-3028
Country	:	US
Telephone Number	:	860-871-3677
Fax Number	:	860-871-3687

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MRS. MARY T GENTILE
Credential	:
Telephone Number	:	800-452-8191

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	04/02/2009

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Directions to “TOWN OF TOLLAND ” Practice Location

Language	Start Address	Practice Location

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