Killingworth Ambulance Association, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

E5415 Issued in CT

Legal business name

KILLINGWORTH AMBULANCE ASSOCIATION, INC

Practice address

325 Route 81
Killingworth, CT 06419-9999

Phone

(860) 663-3634

Fax

(860) 663-3795

NPI assigned

Jul 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Daniel E O'Sullivan

Title

President

Phone

(860) 663-2450

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1023048261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 ROUTE 80",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064191400",
            "telephone_number": "860-663-3634",
            "fax_number": "860-663-3795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ROUTE 81",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064199999",
            "telephone_number": "860-663-3634",
            "fax_number": "860-663-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILLINGWORTH AMBULANCE ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "O'SULLIVAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-663-2450",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "CT",
            "license": "E5415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "699842",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590014003",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004010492",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "710C070A2CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "CT2195",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fresh Start Counseling & Wellness LLC
• Georgios D Giambanis, PHARMACIST
• Emma Gulick, LMSW
• Justine Elise Jarvie, ASSOCIATE LMFT
• Kimberly Doyle Joyner, LMFT
• Killingworth Family Pharmacy Inc
• Jessie Larson, M.D.
• Rachael K. Leombruno, LMFT
• Keith D Lyke, RPH
• Mandy Major, PCD

• Land Ambulance in Killingworth, CT
• Providers in Killingworth, CT by specialty
• Land Ambulance in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.