Provider Demographics
NPI:1013918408
Name:KB AMBULANCE CORPS, INC.
Entity Type:Organization
Organization Name:KB AMBULANCE CORPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:DAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-774-7625
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-0209
Mailing Address - Country:US
Mailing Address - Phone:860-774-7625
Mailing Address - Fax:860-779-2069
Practice Address - Street 1:294 WESTCOTT ROAD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-0209
Practice Address - Country:US
Practice Address - Phone:860-774-7625
Practice Address - Fax:860-779-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC069B1341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004135184Medicaid
CT710C069B1CT01OtherANTHEM BLUE CROSS BLUE SHIELD
CT710C069B1CT01OtherANTHEM BLUE CROSS BLUE SHIELD