Provider Demographics
NPI:1346213279
Name:TOWN OF SCOTLAND
Entity type:Organization
Organization Name:TOWN OF SCOTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-450-1525
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-0503
Mailing Address - Country:US
Mailing Address - Phone:860-828-2002
Mailing Address - Fax:860-828-2005
Practice Address - Street 1:ROUTE 14
Practice Address - Street 2:
Practice Address - City:SCOTLAND
Practice Address - State:CT
Practice Address - Zip Code:06264
Practice Address - Country:US
Practice Address - Phone:860-450-1525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710C123A2CT01OtherBLUE CROSS/BLUE SHIELD
CV2066OtherHEALTHNET
CT004242088Medicaid
CT590000201Medicare ID - Type Unspecified