Provider Demographics
NPI:1386716439
Name:PUTNAM EMS AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:PUTNAM EMS AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:860-928-6549
Mailing Address - Street 1:269 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2361
Mailing Address - Country:US
Mailing Address - Phone:860-638-1818
Mailing Address - Fax:860-638-1802
Practice Address - Street 1:191 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-779-7209
Practice Address - Fax:860-779-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
CTC116B13416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
802178OtherCOMMUNITY HEALTH NETWORK
710C116B1CT01OtherANTHEM BLUE CROSS BLUE SH
004112877OtherEDS
CT0370OtherHEALTHNET
590000116Medicare UPIN