1134235104 NPI number — CLINTON VOLUNTEER FIRE DEPARTMENT INC

Table of content: (NPI 1134235104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134235104 NPI number — CLINTON VOLUNTEER FIRE DEPARTMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINTON VOLUNTEER FIRE DEPARTMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134235104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06405-0165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-663-3634
Provider Business Mailing Address Fax Number:
860-452-4430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 EAST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06413-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-669-8131
Provider Business Practice Location Address Fax Number:
860-669-7650
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEWELLYN
Authorized Official First Name:
JASON
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DEPUTY CHIEF/EMS
Authorized Official Telephone Number:
860-669-8131

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  CO27B1 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004243846 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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