Healthcare Provider Details

I. General information

NPI: 1073981536
Provider Name (Legal Business Name): OLD MYSTIC FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 COW HILL RD
MYSTIC CT
06355-1407
US

IV. Provider business mailing address

295 COW HILL RD
MYSTIC CT
06355-1407
US

V. Phone/Fax

Practice location:
  • Phone: 860-536-2220
  • Fax: 860-536-7811
Mailing address:
  • Phone: 860-536-2220
  • Fax: 860-536-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH W. RICHARDS JR.
Title or Position: FIRE CHIEF/FIRE MARSHAL
Credential:
Phone: 860-536-2220