Healthcare Provider Details

I. General information

NPI: 1386716439
Provider Name (Legal Business Name): PUTNAM EMS AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 CHURCH STREET
PUTNAM CT
06260
US

IV. Provider business mailing address

269 MAIN ST
CROMWELL CT
06416-2361
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-7209
  • Fax: 860-779-7210
Mailing address:
  • Phone: 860-638-1818
  • Fax: 860-638-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberC116B1
License Number StateCT

VIII. Authorized Official

Name: EDWIN C HIGGINS III
Title or Position: PRESIDENT
Credential:
Phone: 860-928-6549