Town of Mansfield

Primary specialty

AmbulanceTaxonomy code 341600000X

License

C078B3 Issued in CT

Legal business name

TOWN OF MANSFIELD

Practice address

4 S Eagleville Rd
Storrs Mansfield, CT 06268-2574

Phone

(860) 429-5290

Fax

(860) 429-3233

NPI assigned

Oct 26, 2005

Organization subpart

No

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

(860) 257-9201

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280966400000",
    "number": "1831189380",
    "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": "860-257-9201",
            "fax_number": "860-721-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 S EAGLEVILLE RD",
            "city": "STORRS MANSFIELD",
            "state": "CT",
            "postal_code": "062682574",
            "telephone_number": "860-429-5290",
            "fax_number": "860-429-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF MANSFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2010-08-05",
        "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": "860-257-9201",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "CT",
            "license": "C078B3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004173209",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590011509",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Storrs Family Medicine
• Ami H Tajudeen, PHARMD
• Sheila J Thompson, MA, LADC
• David Tiberio, PT
• William Toomey
• Town of Mansfield Department of Education
• Ellen Donohue Tulman, BCBA
• Peter Tyczkowski, R.PH.
• University of Connecticut
• University of Connecticut

• Ambulance in Storrs Mansfield, CT
• Providers in Storrs Mansfield, CT by specialty
• Ambulance in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.