Provider Demographics
NPI:1245225887
Name:TOWN OF LEDYARD
Entity Type:Organization
Organization Name:TOWN OF LEDYARD
Other - Org Name:LEDYARD VOL. EMERGENCY SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-464-8222
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:860-638-1800
Mailing Address - Fax:860-638-1802
Practice Address - Street 1:741 R COL LEDYARD HIGHWAY
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339
Practice Address - Country:US
Practice Address - Phone:860-464-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6659OtherHEALTHNET
710C072B1CT01OtherBLUE CROSS/BLUE SHIELD
CT004161444Medicaid
590010517OtherRAILROAD MEDICARE
590000150Medicare ID - Type Unspecified