Provider Demographics
NPI:1184615684
Name:BRISTOL HOSPITAL EMS, LLC
Entity type:Organization
Organization Name:BRISTOL HOSPITAL EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:860-585-3024
Mailing Address - Street 1:371 TERRYVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4029
Mailing Address - Country:US
Mailing Address - Phone:860-585-3157
Mailing Address - Fax:860-585-3110
Practice Address - Street 1:371 TERRYVILLE AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4029
Practice Address - Country:US
Practice Address - Phone:860-585-3679
Practice Address - Fax:860-585-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL017P2341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004201117Medicaid
CT004201117Medicaid