MEDICARE: BOZRAH VOLUNTEER FIRE COMPANY INC

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	C013B1	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	710C013B1CT01	OTHER	CT	BLUE CROSS AND BLUE SHIELD
3	ZA1808	OTHER	CT	HEALTHNET

General Provider Information

NPI Number	:	1265539431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOZRAH VOLUNTEER FIRE COMPANY INC

Provider Business Mailing Address
First Line	:	269 MAIN ST
Second Line	:
City	:	CROMWELL
State	:	CT
Zip	:	06416-2302
Country	:	US
Telephone Number	:	860-638-1800
Fax Number	:	860-638-1802

Provider Business Practice Location Address
First Line	:	239 FITCHVILLE RD
Second Line	:
City	:	BOZRAH
State	:	CT
Zip	:	06334-1111
Country	:	US
Telephone Number	:	860-887-9474
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRED POTTER
Credential	:
Telephone Number	:	860-887-9474

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/18/2013

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Directions to “BOZRAH VOLUNTEER FIRE COMPANY INC ” Practice Location

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