Provider Demographics
NPI:1114919305
Name:EAST WINDSOR AMBULANCE ASSOC
Entity Type:Organization
Organization Name:EAST WINDSOR AMBULANCE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CHIEF
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 WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-9511
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:2005-08-16
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT341600000X
CTC047P13416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004138055Medicaid
104834400OtherDEPT OF LABOR
777989OtherCONNECTICARE
590009265OtherRAILROAD MEDICARE
590009265OtherRAILROAD MEDICARE
104834400OtherDEPT OF LABOR