MEDICARE: EAST HADDAM AMBULANCE ASSOC 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590014967	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
3	710C041A2CT01	OTHER		BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1801896634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST HADDAM AMBULANCE ASSOC INC

Provider Business Mailing Address
First Line	:	195 ROUTE 80
Second Line	:
City	:	KILLINGWORTH
State	:	CT
Zip	:	06419-1400
Country	:	US
Telephone Number	:	860-873-2838
Fax Number	:	860-828-2144

Provider Business Practice Location Address
First Line	:	440 TOWN ST.
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423
Country	:	US
Telephone Number	:	860-873-2838
Fax Number	:	860-446-0130

Authorized Official
Title or Position	:	SERVICE ADMIN.
Name	:	MRS. TIFFANY S QUINN
Credential	:
Telephone Number	:	860-873-5058

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/04/2013

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