1275861643 NPI number — TOWN OF WILTON

Table of content: (NPI 1275861643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275861643 NPI number — TOWN OF WILTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF WILTON
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:
WILTON AMBULANCE
Provider Other Organization Name Type Code:
3
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:
1275861643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 MAIN ST UNIT 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETERBOROUGH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03458-2467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-924-7797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 FOREST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-654-2222
Provider Business Practice Location Address Fax Number:
603-654-3307
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BOISSONAULT
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
CHAIRPERSON
Authorized Official Telephone Number:
570-271-1120

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0121 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 0121 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00978698 . This is a "RR MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 001473901 . This is a "NH MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3070917 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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