=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992705743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN LEGION COMMUNITY AMBULANCE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2005
-----------------------------------------------------
Last Update Date | 09/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 SOULE ST
-----------------------------------------------------
City | JEWETT CITY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06351-2217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-376-3080
-----------------------------------------------------
Fax | 860-376-7703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 269 MAIN ST
-----------------------------------------------------
City | CROMWELL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06416-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-638-1800
-----------------------------------------------------
Fax | 860-638-1802
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BILL CZMYR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-376-3080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------