Provider Demographics
NPI:1275861643
Name:TOWN OF WILTON
Entity Type:Organization
Organization Name:TOWN OF WILTON
Other - Org Name:WILTON AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BOISSONAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-1120
Mailing Address - Street 1:70 MAIN ST UNIT 200
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2467
Mailing Address - Country:US
Mailing Address - Phone:603-924-7797
Mailing Address - Fax:
Practice Address - Street 1:404 FOREST RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:NH
Practice Address - Zip Code:03086
Practice Address - Country:US
Practice Address - Phone:603-654-2222
Practice Address - Fax:603-654-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0121341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP00978698OtherRR MEDICARE
NH001473901OtherNH MEDICARE
NH3070917Medicaid