MEDICARE: TOWN OF STRATFORD, CONNECTICUT

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	341600000X	Ambulance	C138P1	CT
2	3416L0300X	Land Ambulance	C138P1	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00078413	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508854928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF STRATFORD, CONNECTICUT

Provider Business Mailing Address
First Line	:	PO BOX 417697
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-7697
Country	:	US
Telephone Number	:	203-385-4060
Fax Number	:	203-385-4156

Provider Business Practice Location Address
First Line	:	2712 MAIN ST
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06615-5816
Country	:	US
Telephone Number	:	203-385-4060
Fax Number	:	203-385-4156

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	JAY WAHLBERG
Credential	:
Telephone Number	:	203-385-4040

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/09/2018

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Directions to “TOWN OF STRATFORD, CONNECTICUT ” Practice Location

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