Provider Demographics
NPI:1114973245
Name:DURHAM VOLUNTEER AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:DURHAM VOLUNTEER AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-349-9966
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-0207
Mailing Address - Country:US
Mailing Address - Phone:860-663-3634
Mailing Address - Fax:860-663-3795
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-2108
Practice Address - Country:US
Practice Address - Phone:860-663-3634
Practice Address - Fax:860-663-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE54553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCW0088OtherHEALTHNET
CT710C038B1CT01OtherANTHEM BLUE CROSS
CT506411OtherCONNECTICARE
CT004243789Medicaid
CT590000063Medicare ID - Type Unspecified
CT004243789Medicaid