Provider Demographics
NPI:1093821431
Name:EAST WINDSOR AMBULANCE ASSOC. INC.
Entity Type:Organization
Organization Name:EAST WINDSOR AMBULANCE ASSOC. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLYNCH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:860-654-0515
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-0188
Mailing Address - Country:US
Mailing Address - Phone:860-654-0515
Mailing Address - Fax:860-623-5289
Practice Address - Street 1:25 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:EAST WINDOSR
Practice Address - State:CT
Practice Address - Zip Code:06088
Practice Address - Country:US
Practice Address - Phone:860-654-0515
Practice Address - Fax:860-623-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT341600000X
CTC047P13416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004138055Medicaid
590000144Medicare ID - Type Unspecified