Healthcare Provider Details

I. General information

NPI: 1265539431
Provider Name (Legal Business Name): BOZRAH VOLUNTEER FIRE COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 FITCHVILLE RD
BOZRAH CT
06334-1111
US

IV. Provider business mailing address

269 MAIN ST
CROMWELL CT
06416-2302
US

V. Phone/Fax

Practice location:
  • Phone: 860-887-9474
  • Fax:
Mailing address:
  • Phone: 860-638-1800
  • Fax: 860-638-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberC013B1
License Number StateCT

VIII. Authorized Official

Name: FRED POTTER
Title or Position: PRESIDENT
Credential:
Phone: 860-887-9474