Provider Demographics
NPI:1558359992
Name:TOWN OF WALLINGFORD
Entity Type:Organization
Organization Name:TOWN OF WALLINGFORD
Other - Org Name:WALLINGFORD DEPT. OF FIRE SVS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:HEIDGERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-294-2730
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:978-356-2721
Practice Address - Street 1:75 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3019
Practice Address - Country:US
Practice Address - Phone:203-294-2730
Practice Address - Fax:203-294-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL148P1341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
710L148B2CT01OtherBLUE CROSS
CT3290OtherHEALTHNET
8170770OtherAETNA
CT004072295Medicaid
105268200OtherDEPT OF LABOR
CT590069046OtherRAILROAD MEDICARE
CT590069046OtherRAILROAD MEDICARE