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General NPI Number Information
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NPI Number | 1699760249
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Entity Type | Organization
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Legal Business Name | MYSTIC RIVER AMBULANCE ASSOCIATION, INC
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 237 SANDY HOLLOW RD
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City | MYSTIC
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State | CT
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Zip | 06355-1617
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Country | US
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Telephone | 860-572-0283
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 165
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City | BRANFORD
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State | CT
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Zip | 06405-0165
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Country | US
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Telephone | 860-452-4500
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Fax | 860-452-4430
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEO TODD MCDONNELL
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Credential |
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Telephone | 860-572-0283
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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 |
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License Number State |
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