Aetna Ambulance Service, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

L064P2 Issued in CT

Legal business name

AETNA AMBULANCE SERVICE, INC

Practice address

140 Van Block Ave
Hartford, CT 06106-2845

Phone

(860) 247-6792

Fax

(860) 724-3384

NPI assigned

Mar 26, 2007

Last updated

May 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Wayne Alfred Wright

Title

President

Phone

(860) 647-9798

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1194842781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1150",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060451150",
            "telephone_number": "860-240-7575",
            "fax_number": "860-643-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 VAN BLOCK AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062845",
            "telephone_number": "860-247-6792",
            "fax_number": "860-724-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AETNA AMBULANCE SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "ALFRED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-647-9798",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "CT",
            "license": "L064P2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004072120",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Hartford, CT
• Providers in Hartford, 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 13, 2008; 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.