Bantam Fire Company
Organization Active NPI Land Ambulance · Bantam, CT
NPI 1255729349 · NPPES record last updated Dec 26, 2014
Key facts
- NPI
- 1255729349
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- C074B1 (CT)
- Legal business name
- BANTAM FIRE COMPANY
- Practice address
- 92 Doyle Rd
Bantam, CT 06750-0456 - Phone
- (860) 567-5198
- NPI assigned
- Dec 26, 2014
- Organization subpart
- No
Authorized official
- Name
- Richard W Duffy
- Title
- Chief
- Phone
- (860) 567-5198
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2113906 | Bantam Fire Company | Certificate of waiver | Jun 1, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150709001729 | CT | Part B Supplier - Ambulance Service Supplier | 1355653965 | Practice locations: Bantam, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | C074B1 | CT | Yes |
Addresses
Primary practice location
92 Doyle Rd
Bantam, CT 06750-0456
Mailing address
269 Main St
Cromwell, CT 06416-2361
Phone (860) 638-1800
Other providers in Bantam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.