Provider Demographics
NPI:1700859808
Name:WOODSTOCK VOLUNTEER FIRE ASSOC INC
Entity Type:Organization
Organization Name:WOODSTOCK VOLUNTEER FIRE ASSOC INC
Other - Org Name:WOODSTOCK EMS/WVFA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-928-3163
Mailing Address - Street 1:269 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2302
Mailing Address - Country:US
Mailing Address - Phone:860-638-1800
Mailing Address - Fax:860-638-1802
Practice Address - Street 1:30 NEW SWEDEN RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-3211
Practice Address - Country:US
Practice Address - Phone:860-928-3163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
710C169B1CT01OtherBLUE CROSS/BLUE SHIELD
CT004174760Medicaid
CT004174760Medicaid