Healthcare Provider Details

I. General information

NPI: 1184126690
Provider Name (Legal Business Name): YELLOW CAB COMPANY OF NEW LONDON AND GROTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CROSS RD
WATERFORD CT
06385-1215
US

IV. Provider business mailing address

176 CROSS RD
WATERFORD CT
06385-1215
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-1655
  • Fax: 860-447-3383
Mailing address:
  • Phone: 860-443-1655
  • Fax: 860-447-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number146
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number68
License Number StateCT

VIII. Authorized Official

Name: JOSEPH MILLER
Title or Position: RISK MANAGER
Credential:
Phone: 860-443-1655