Provider Demographics
NPI:1720070915
Name:EAST GRANBY AMBULANCE ASSN
Entity Type:Organization
Organization Name:EAST GRANBY AMBULANCE ASSN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-653-4165
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-0282
Mailing Address - Country:US
Mailing Address - Phone:860-668-3885
Mailing Address - Fax:860-668-3885
Practice Address - Street 1:6 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9632
Practice Address - Country:US
Practice Address - Phone:860-653-4165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC040B1341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
00418650900OtherBLUE CARE FAMILY
P00006599OtherRAILROAD MEDICARE
CT004186509Medicaid
356979800OtherDEPT OF LABOR
701985OtherCONNECTICARE
CT710C040B1CT01OtherANTHEM BLUECROSSBLUESHIEL
CT004186509Medicaid
00418650900OtherBLUE CARE FAMILY