=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801881651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITCHFIELD AMBULANCE ASSOCIATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 05/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 EAST ST
-----------------------------------------------------
City | LITCHFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06759-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-567-9132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 ROUTE 80
-----------------------------------------------------
City | KILLINGWORTH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06419-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-663-3634
-----------------------------------------------------
Fax | 860-663-3634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN JOSEPH PUDLINSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-567-0127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------