# KILLINGWORTH AMBULANCE ASSOCIATION, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023048261
- **Authorized official:** MR. DANIEL E O'SULLIVAN (PRESIDENT)
- **Authorized official phone:** (860) 663-2450

## Contact information

- **Practice address:** 325 ROUTE 81, KILLINGWORTH, CT 06419-9999
- **Practice address phone:** (860) 663-3634
- **Practice address fax:** (860) 663-3795
- **Mailing address:** 195 ROUTE 80, KILLINGWORTH, CT 06419-1400
- **Mailing address phone:** (860) 663-3634
- **Mailing address fax:** (860) 663-3795

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | E5415 | CT | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 05/01/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004010492 | — | CT |
| 01 | — | 590014003 | RAILROAD MEDICARE | CT |
| 01 | — | 699842 | CONNECTICARE | CT |
| 01 | — | 710C070A2CT01 | ANTHEM BLUE CROSS | CT |
| 01 | — | CT2195 | HEALTHNET | CT |