Provider Demographics
NPI:1801896634
Name:EAST HADDAM AMBULANCE ASSOC INC
Entity type:Organization
Organization Name:EAST HADDAM AMBULANCE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE ADMIN.
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:S
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-873-5058
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:860-873-2838
Mailing Address - Fax:860-828-2144
Practice Address - Street 1:440 TOWN ST.
Practice Address - Street 2:
Practice Address - City:EAST HADDAM
Practice Address - State:CT
Practice Address - Zip Code:06423
Practice Address - Country:US
Practice Address - Phone:860-873-2838
Practice Address - Fax:860-446-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590014967OtherRAILROAD MEDICARE
CT004010187Medicaid
710C041A2CT01OtherBLUE CROSS/BLUE SHIELD
CT590000174Medicare PIN