Healthcare Provider Details

I. General information

NPI: 1114973245
Provider Name (Legal Business Name): DURHAM VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST
DURHAM CT
06422-2108
US

IV. Provider business mailing address

PO BOX 207
DURHAM CT
06422-0207
US

V. Phone/Fax

Practice location:
  • Phone: 860-663-3634
  • Fax: 860-663-3795
Mailing address:
  • Phone: 860-663-3634
  • Fax: 860-663-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberE5455
License Number StateCT

VIII. Authorized Official

Name: MR. THOMAS WIMLER
Title or Position: CHIEF OF SERVICE
Credential:
Phone: 860-349-9966