Provider Demographics
NPI:1114912862
Name:MIDDLEBURY VOLUNTEER FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:MIDDLEBURY VOLUNTEER FIRE DEPARTMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERROTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-577-4036
Mailing Address - Street 1:269 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2302
Mailing Address - Country:US
Mailing Address - Phone:800-437-8347
Mailing Address - Fax:860-638-1802
Practice Address - Street 1:65 TUCKER HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2512
Practice Address - Country:US
Practice Address - Phone:203-577-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590010128OtherRAILROAD MEDICARE
710C018B2CT01OtherBLUE CROSS/BLUE SHIELD
CT8389OtherHEALTHNET
CT004164521Medicaid
CT004164521Medicaid