Healthcare Provider Details

I. General information

NPI: 1144218546
Provider Name (Legal Business Name): SOUTH WINDSOR AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151A SAND HILL RD
SOUTH WINDSOR CT
06074-2094
US

IV. Provider business mailing address

8 TURCOTTE MEMORIAL DR
ROWLEY MA
01969-1706
US

V. Phone/Fax

Practice location:
  • Phone: 860-648-6246
  • Fax: 860-644-1572
Mailing address:
  • Phone: 800-488-4351
  • Fax: 978-356-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberC132B1
License Number StateCT

VIII. Authorized Official

Name: MR. PHIL FLUERY
Title or Position: EMS DIRECTOR
Credential:
Phone: 860-282-0669