Provider Demographics
NPI:1932105293
Name:BETHLEHEM AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:BETHLEHEM AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-266-7890
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:83 MAIN STREET SOUTH
Mailing Address - City:BETHLEHEM
Mailing Address - State:CT
Mailing Address - Zip Code:06751-0401
Mailing Address - Country:US
Mailing Address - Phone:203-266-6666
Mailing Address - Fax:203-266-5535
Practice Address - Street 1:MAIN ST SOUTH
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:CT
Practice Address - Zip Code:06751
Practice Address - Country:US
Practice Address - Phone:203-266-6666
Practice Address - Fax:203-266-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
710C010AZCT01OtherBCBS
CT004224292Medicaid
CU7382OtherPHS
00422429200OtherBLUE CARE FAMILY PLAN
709773OtherCONNECTICARE
=========OtherHEALTHNET
CU7382OtherPHS
709773OtherCONNECTICARE
710C010AZCT01OtherBCBS
CT590000172Medicare ID - Type Unspecified
CT004224292Medicaid