Provider Demographics
NPI:1457351306
Name:ANDOVER VOLUNTEER FIRE DEPARTMENT, INC.
Entity Type:Organization
Organization Name:ANDOVER VOLUNTEER FIRE DEPARTMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-742-7477
Mailing Address - Street 1:11 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1556
Mailing Address - Country:US
Mailing Address - Phone:860-742-7477
Mailing Address - Fax:860-742-4047
Practice Address - Street 1:11 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:CT
Practice Address - Zip Code:06232-1526
Practice Address - Country:US
Practice Address - Phone:860-742-7477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
004235835OtherCOMMUNITY HEALTH
710C001B1CT01OtherBLUE CROSS/BLUE SHIELD
004235835OtherPREFERRED ONE
CT004235835Medicaid
=========00OtherBLUE CARE FAMILY PLAN
CT590000220Medicare ID - Type Unspecified
CT004235835Medicaid