1912446956 NPI number — TOWN OF COVENTRY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912446956 NPI number — TOWN OF COVENTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF COVENTRY
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:
TOWN OF COVENTRY FIRE/EMS
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:
1912446956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1712 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVENTRY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06238-3615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-488-4351
Provider Business Mailing Address Fax Number:
978-356-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1712 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVENTRY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06238-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-531-2563
Provider Business Practice Location Address Fax Number:
860-742-8911
Provider Enumeration Date:
02/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ELSESSER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
TOWN MANAGER
Authorized Official Telephone Number:
860-742-6324

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  C-032B2 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: C-032B2 , 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)





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