Provider Demographics
NPI:1922090117
Name:TOWN OF SOMERS
Entity Type:Organization
Organization Name:TOWN OF SOMERS
Other - Org Name:SOMERS FIRE DEPT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-763-8200
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-0098
Mailing Address - Country:US
Mailing Address - Phone:860-668-3885
Mailing Address - Fax:860-668-3885
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1918
Practice Address - Country:US
Practice Address - Phone:860-749-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC129B1341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
201064700OtherDEPT OF LABOR
710C129B1CT01OtherANTHEM BCBS
CT004188969Medicaid
768025OtherCONNECTICARE
P00134993OtherRAILROAD MEDICARE
590000175Medicare ID - Type Unspecified