Roy B Pettengill Amb Assoc
Organization Active NPI Land Ambulance · Marlborough, CT
NPI 1750379293 · NPPES record last updated Nov 4, 2025
Key facts
- NPI
- 1750379293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- C079B1 (CT)
- Legal business name
- ROY B PETTENGILL AMB ASSOC
- Practice address
- 7 Hebron Rd
Marlborough, CT 06447-1202 - Phone
- (860) 295-6219
- Fax
- (860) 295-0604
- NPI assigned
- Oct 10, 2005
- Organization subpart
- No
Authorized official
- Name
- Lori A Tarka
- Title
- President
- Phone
- (860) 402-5899
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070329000173 | CT | Part B Supplier - Ambulance Service Supplier | 0345344412 | Practice locations: Marborough, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | C079B1 | CT | Yes |
Addresses
Primary practice location
7 Hebron Rd
Marlborough, CT 06447-1202
Mailing address
PO Box 165
Branford, CT 06405-0165
Phone (860) 663-3634
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004224565 | Medicaid | CT |
Other providers in Marlborough, CT
- Michael D Reife
- Sharon Leigh Remkiewicz
- Jennifer Rey
- Lizbette Rivera
- Root Physical Therapy
- Lawrence P Ryan
- Anita Schubert
- Seeds of Hope, LLC
- Natalia Maria Seguro-Wright
- Raymond A Shaw Jr.
All providers in Marlborough, CT · Land Ambulance in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.