Provider Demographics
NPI:1689647513
Name:WOODBURY AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:WOODBURY AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLIVINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-263-5252
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:BEACON FALLS
Mailing Address - State:CT
Mailing Address - Zip Code:06403-0131
Mailing Address - Country:US
Mailing Address - Phone:203-729-2800
Mailing Address - Fax:203-729-2808
Practice Address - Street 1:426 MAIN ST N
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-2128
Practice Address - Country:US
Practice Address - Phone:203-263-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004173457Medicaid
CU6042OtherHEALTHNET
710C168A2CT01OtherBLUE CROSS/BLUE SHIELD
CT590000160Medicare PIN