Provider Demographics
NPI:1679697189
Name:WETHERSFIELD VOLUNTEER AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:WETHERSFIELD VOLUNTEER AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:RINICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-597-2898
Mailing Address - Street 1:206 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3638
Mailing Address - Country:US
Mailing Address - Phone:860-597-2898
Mailing Address - Fax:
Practice Address - Street 1:206 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3638
Practice Address - Country:US
Practice Address - Phone:860-597-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT590000130Medicare UPIN
CT590000130Medicare Oscar/Certification
CT590000130Medicare ID - Type Unspecified
CT590000130Medicare PIN