1912995374 NPI number — WINDSOR VOLUNTEER AMBULANCE INC

Table of content: (NPI 1912995374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912995374 NPI number — WINDSOR VOLUNTEER AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDSOR VOLUNTEER AMBULANCE 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:
6
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:
1912995374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42002-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-744-9600
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 BLOOMFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06095-7211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-688-8244
Provider Business Practice Location Address Fax Number:
860-688-8891
Provider Enumeration Date:
10/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOYLAN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
860-688-8244

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  C164P1 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00039327 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004105450 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".