Provider Demographics
NPI:1154397610
Name:WARREN WENTWORTH AMBULANCE SERVICE
Entity type:Organization
Organization Name:WARREN WENTWORTH AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:603-764-9494
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NH
Mailing Address - Zip Code:03279-0219
Mailing Address - Country:US
Mailing Address - Phone:603-764-9494
Mailing Address - Fax:603-764-9499
Practice Address - Street 1:446 ROUTE 25
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NH
Practice Address - Zip Code:03279
Practice Address - Country:US
Practice Address - Phone:603-764-9316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
7103290Y0NH01OtherANTHEM BCBS
590009517OtherRR MEDICARE
NH30006485Medicaid
703372OtherHARVARD PILGRIM
590009517OtherRR MEDICARE