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General NPI Number Information
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NPI Number | 1194842781
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Entity Type | Organization
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Legal Business Name | AETNA AMBULANCE SERVICE, INC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 140 VAN BLOCK AVE
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City | HARTFORD
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State | CT
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Zip | 06106-2845
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Country | US
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Telephone | 860-247-6792
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Fax | 860-724-3384
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Provider Business Mailing Address
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Address Line | PO BOX 1150
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City | MANCHESTER
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State | CT
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Zip | 06045-1150
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Country | US
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Telephone | 860-240-7575
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Fax | 860-643-0759
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WAYNE ALFRED WRIGHT
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Credential |
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Telephone | 860-647-9798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | L064P2
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License Number State | CT
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