Healthcare Provider Details

I. General information

NPI: 1730177171
Provider Name (Legal Business Name): CLINTON VOLUNTEER FIRE DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E MAIN ST
CLINTON CT
06413-2049
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-8131
  • Fax: 860-664-7650
Mailing address:
  • Phone: 800-452-8191
  • Fax: 860-721-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberC027B1
License Number StateCT

VIII. Authorized Official

Name: MS. HEATHER M LIZOTTE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 800-452-8191