MEDICARE: SEYMOUR AMBULANCE ASSOCIATION 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	341600000X	Ambulance	C124I1	CT
2	3416L0300X	Land Ambulance	C124I1	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00367360	OTHER	CT	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	710C124I1CT01	OTHER	CT	BLUE CROSS/BLUE SHIELD
2	759084	OTHER	CT	CONNECTICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	CU0589	OTHER		HEALTHNET

General Provider Information

NPI Number	:	1942273123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEYMOUR AMBULANCE ASSOCIATION INC

Provider Business Mailing Address
First Line	:	4 WAKELEY ST
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-2820
Country	:	US
Telephone Number	:	203-888-8843
Fax Number	:	203-881-5018

Provider Business Practice Location Address
First Line	:	4 WAKELEY ST
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-2820
Country	:	US
Telephone Number	:	203-888-8843
Fax Number	:	203-881-5018

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KYLE KELLEY
Credential	:
Telephone Number	:	203-888-8843

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	08/16/2016

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Directions to “SEYMOUR AMBULANCE ASSOCIATION INC ” Practice Location

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