Healthcare Provider Details

I. General information

NPI: 1013918408
Provider Name (Legal Business Name): KB AMBULANCE CORPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 WESTCOTT ROAD
DANIELSON CT
06239-0209
US

IV. Provider business mailing address

PO BOX 209
DANIELSON CT
06239-0209
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-7625
  • Fax: 860-779-2069
Mailing address:
  • Phone: 860-774-7625
  • Fax: 860-779-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberC069B1
License Number StateCT

VIII. Authorized Official

Name: MR. GEORGE RANDOLPH DAGGETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-774-7625