Healthcare Provider Details

I. General information

NPI: 1679568323
Provider Name (Legal Business Name): THE MOHEGAN FIRE COMPANY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 NORWICH NEW LONDON TPKE
UNCASVILLE CT
06382-1330
US

IV. Provider business mailing address

2029 NORWICH NEW LONDON TPKE
UNCASVILLE CT
06382-1330
US

V. Phone/Fax

Practice location:
  • Phone: 860-848-3004
  • Fax:
Mailing address:
  • Phone: 608-483-0048
  • Fax: 860-848-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: COREY GAETANO
Title or Position: CHIEF
Credential:
Phone: 860-848-3004