Provider Demographics
NPI:1073981536
Name:OLD MYSTIC FIRE DISTRICT
Entity Type:Organization
Organization Name:OLD MYSTIC FIRE DISTRICT
Other - Org Name:OLD MYSTIC FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF/FIRE MARSHAL
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-536-2220
Mailing Address - Street 1:295 COW HILL RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1407
Mailing Address - Country:US
Mailing Address - Phone:860-536-2220
Mailing Address - Fax:860-536-7811
Practice Address - Street 1:295 COW HILL RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1407
Practice Address - Country:US
Practice Address - Phone:860-536-2220
Practice Address - Fax:860-536-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty