Provider Demographics
NPI:1497985477
Name:TOWN OF CONWAY
Entity Type:Organization
Organization Name:TOWN OF CONWAY
Other - Org Name:TOWN OF CONWAY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-369-4235
Mailing Address - Street 1:9 MAIN ST STE 2K
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-1660
Mailing Address - Country:US
Mailing Address - Phone:413-369-4235
Mailing Address - Fax:413-369-4237
Practice Address - Street 1:32 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MA
Practice Address - Zip Code:01341-0412
Practice Address - Country:US
Practice Address - Phone:413-369-4235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA013159OtherBCBS
MAAM0006Medicare PIN