Provider Demographics
NPI:1942273123
Name:SEYMOUR AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:SEYMOUR AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-888-8843
Mailing Address - Street 1:4 WAKELEY ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2820
Mailing Address - Country:US
Mailing Address - Phone:203-888-8843
Mailing Address - Fax:203-881-5018
Practice Address - Street 1:4 WAKELEY ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2820
Practice Address - Country:US
Practice Address - Phone:203-888-8843
Practice Address - Fax:203-881-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC124I1341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710C124I1CT01OtherBLUE CROSS/BLUE SHIELD
CT759084OtherCONNECTICARE
CT004125664Medicaid
CU0589OtherHEALTHNET
CTP00367360OtherRR MEDICARE
CU0589OtherHEALTHNET
CT004125664Medicaid
CT759084OtherCONNECTICARE
CTP00367360OtherRR MEDICARE
CT=========OtherYALE HEALTH PLAN
CT=========OtherLIBERTY MUTUAL INSURANCE