Provider Demographics
NPI:1033101241
Name:SUFFIELD VOLUNTEER AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:SUFFIELD VOLUNTEER AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-668-3881
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:W SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06093-0062
Mailing Address - Country:US
Mailing Address - Phone:860-668-3885
Mailing Address - Fax:860-668-3885
Practice Address - Street 1:205 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2105
Practice Address - Country:US
Practice Address - Phone:860-668-3881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC139I1341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011440Medicaid
104428200OtherDEPT OF LABOR
CT004107787Medicaid
00410778700OtherANTHEM BLUE CARE FAMILY
1720309OtherMASS HEALTH
947163OtherCONNECTICARE
CT710C139I1CT01OtherANTHEM BCBS
590006385OtherRAILROAD MEDICARE
VT1011440Medicaid
CT004107787Medicaid