Provider Demographics
NPI:1679561120
Name:THE BETHANY VOLUNTEER FIREMENS ASSOCIATION INCORPORATED
Entity Type:Organization
Organization Name:THE BETHANY VOLUNTEER FIREMENS ASSOCIATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-393-2799
Mailing Address - Street 1:PO BOX 8879
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-0879
Mailing Address - Country:US
Mailing Address - Phone:401-572-3120
Mailing Address - Fax:401-572-3351
Practice Address - Street 1:765 AMITY RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3028
Practice Address - Country:US
Practice Address - Phone:203-393-2799
Practice Address - Fax:203-234-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC008B1341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4225761Medicaid
590012110OtherRAILROAD MEDICARE
CT590000181Medicare PIN