Provider Demographics
NPI:1942313440
Name:TOWN OF ENFIELD BOARD OF EDUCATION
Entity Type:Organization
Organization Name:TOWN OF ENFIELD BOARD OF EDUCATION
Other - Org Name:TOWN OF ENFIELD EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEMOKLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-253-2543
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:C/O COMSTAR
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:978-356-2721
Practice Address - Street 1:1296 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4912
Practice Address - Country:US
Practice Address - Phone:860-253-5243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC049P1341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710C049B1CT01OtherANTHEM BCBS
P00238538OtherRAILROAD MEDICARE
710C049B1CT01OtherBLUE CARE FAMILY
CT004243622Medicaid
611447600OtherDEPT OF LABOR
661997OtherCONNECTICARE
CT004243622Medicaid