Organization Active NPI

Town of Bloomfield

  • Ambulance
  • Bloomfield, CT
National Provider Identifier
1497743934
Registry record updated Sep 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
C011P1 Issued in CT
Legal business name
TOWN OF BLOOMFIELD
Practice address
12 South Wood Drive
Bloomfield, CT 06002-2444
Phone
(860) 243-3482
Fax
(860) 242-9316
NPI assigned
Oct 10, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2010

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

Authorized official

Name
Ms. Mary T Gentile
Title
Authorized Agent
Phone
(800) 452-8191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X C011P1 CT Primary

Addresses

Primary practice location

12 South Wood Drive
Bloomfield, CT 06002-2444

Mailing address

PO Box 290184
Wethersfield, CT 06129-0184
Phone (800) 452-8191

Other identifiers 1

IdentifierTypeStateIssuer
004099174MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090507000150 CT Part B Supplier - Ambulance Service Supplier 1557419223 Practice locations: Bloomfield, CT

National Provider Directory

National Provider Directory

Locations

800 Bloomfield Ave
Bloomfield, CT 06002

785 Park Ave
Bloomfield, CT 06002

12 Southwood Dr
Bloomfield, CT 06002
Phone (860) 243-3482

NPI Registry JSON

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283385600000",
    "number": "1497743934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290184",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061290184",
            "telephone_number": "800-452-8191",
            "fax_number": "860-721-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SOUTH WOOD DRIVE",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022444",
            "telephone_number": "860-243-3482",
            "fax_number": "860-242-9316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF BLOOMFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2010-09-02",
        "status": "A",
        "authorized_official_last_name": "GENTILE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "800-452-8191",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "CT",
            "license": "C011P1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004099174",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; 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.