Provider Demographics
NPI:1922008770
Name:GLASTONBURY VOLUNTEER AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:GLASTONBURY VOLUNTEER AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-336-6402
Mailing Address - Street 1:PO BOX 290184
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0184
Mailing Address - Country:US
Mailing Address - Phone:860-257-7080
Mailing Address - Fax:860-721-6362
Practice Address - Street 1:2112 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2285
Practice Address - Country:US
Practice Address - Phone:860-633-6554
Practice Address - Fax:860-657-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
710C054I1CT01OtherBLUE CROSS/BLUE SHIELD
590009465OtherRAILROAD MEDICARE
CT7135OtherHEALTHNET
CT590000146OtherMEDICARE
CT004141470Medicaid
CT7135OtherHEALTHNET