Provider Demographics
NPI:1477526663
Name:TOWN OF VERNON
Entity Type:Organization
Organization Name:TOWN OF VERNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDDECKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-870-3634
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 1:14 PARK PL
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3291
Practice Address - Country:US
Practice Address - Phone:860-871-7468
Practice Address - Fax:860-870-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT441590050OtherRAILROAD MEDICARE
CT004010229Medicaid
CT8228OtherHEALTHNET
CT710C146A2CT01OtherBLUE CROSS/BLUE SHIELD
CT8228OtherHEALTHNET