Provider Demographics
NPI:1043243538
Name:AMERICAN MEDICAL RESPONSE OF CONNECTICUT INCORPORATED
Entity Type:Organization
Organization Name:AMERICAN MEDICAL RESPONSE OF CONNECTICUT INCORPORATED
Other - Org Name:AMR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0296
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:58 MIDDLETOWN AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-4839
Practice Address - Country:US
Practice Address - Phone:800-379-7700
Practice Address - Fax:800-670-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004072394Medicaid
CT590010202OtherRAILROAD MEDICARE
CT008043785Medicaid
1043243538OtherTRICARE EAST
NY01587719Medicaid
CTCT0000D1000010OtherSECTION 1011