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General NPI Number Information
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NPI Number | 1215929401
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Entity Type | Organization
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Legal Business Name | STAFFORD AMBULANCE ASSOCIATION INC.
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 27 WILLINGTON AVE
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-1620
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Country | US
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Telephone | 860-668-3885
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Fax | 860-668-3885
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | WEST SUFFIELD
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State | CT
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Zip | 06093-0204
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Country | US
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Telephone | 860-668-3885
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Fax | 860-668-3885
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Authorized Official
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Title or Position | AMBULANCE CHIEF
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Name | MR. ALEXANDER MOORE
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Credential |
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Telephone | 860-684-5364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | C134B1
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License Number State | CT
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