Provider Demographics
NPI:1801881651
Name:LITCHFIELD AMBULANCE ASSOCIATION INC
Entity type:Organization
Organization Name:LITCHFIELD AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PUDLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-567-0127
Mailing Address - Street 1:195 ROUTE 80
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1400
Mailing Address - Country:US
Mailing Address - Phone:860-663-3634
Mailing Address - Fax:860-663-3634
Practice Address - Street 1:11 EAST ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3601
Practice Address - Country:US
Practice Address - Phone:860-567-9132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235637Medicaid
710C074B2CT01OtherBLUE CROSS/BLUE SHIELD
CT004235637Medicaid