Healthcare Provider Details

I. General information

NPI: 1699760249
Provider Name (Legal Business Name): MYSTIC RIVER AMBULANCE ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 SANDY HOLLOW RD
MYSTIC CT
06355-1617
US

IV. Provider business mailing address

PO BOX 165
BRANFORD CT
06405-0165
US

V. Phone/Fax

Practice location:
  • Phone: 860-572-0283
  • Fax:
Mailing address:
  • Phone: 860-452-4500
  • Fax: 860-452-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: LEO TODD MCDONNELL
Title or Position: PRESIDENT
Credential:
Phone: 860-572-0283