MEDICARE: GRANBY AMBULANCE ASSOCIATION, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance
2	341600000X	Ambulance	C056B1	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	590010949	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204062000	OTHER		DEPT OF LABOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	706607	OTHER		CONNECTICARE
5	710C056B1CT01	OTHER	CT	ANTHEM BCBS
6	00414973900	OTHER		BLUE CARE FAMILY

General Provider Information

NPI Number	:	1265434690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANBY AMBULANCE ASSOCIATION, INCORPORATED

Provider Business Mailing Address
First Line	:	1 PEGVILLE ROAD
Second Line	:
City	:	GRANBY
State	:	CT
Zip	:	06035-1615
Country	:	US
Telephone Number	:	860-653-6535
Fax Number	:	888-965-4620

Provider Business Practice Location Address
First Line	:	1 PEGVILLE ROAD
Second Line	:
City	:	GRANBY
State	:	CT
Zip	:	06035-1615
Country	:	US
Telephone Number	:	860-653-6535
Fax Number	:	888-965-4620

Authorized Official
Title or Position	:	PRESTIDENT
Name	:	LORI DIBATTISTO
Credential	:
Telephone Number	:	860-653-6535

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	06/04/2020

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Directions to “GRANBY AMBULANCE ASSOCIATION, INCORPORATED ” Practice Location

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