Provider Demographics
NPI:1508854928
Name:TOWN OF STRATFORD, CONNECTICUT
Entity Type:Organization
Organization Name:TOWN OF STRATFORD, CONNECTICUT
Other - Org Name:STRATFORD EMERGENCY MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-385-4040
Mailing Address - Street 1:PO BOX 417697
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7697
Mailing Address - Country:US
Mailing Address - Phone:203-385-4060
Mailing Address - Fax:203-385-4156
Practice Address - Street 1:2712 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5816
Practice Address - Country:US
Practice Address - Phone:203-385-4060
Practice Address - Fax:203-385-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC138P1341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00078413OtherRAILROAD MEDICARE
CT004169480Medicaid
CT590000222Medicare PIN