# MADISON AMBULANCE ASSOCIATION INC

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

## Provider details

- **NPI number:** 1437144284
- **Authorized official:** MR. SAMUEL E. DEBURRA JR. (PRESIDENT)
- **Authorized official phone:** (203) 245-5617

## Contact information

- **Practice address:** 9 OLD ROUTE 79, MADISON, CT 06443-2604
- **Practice address phone:** (203) 245-9821
- **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 | C076P1 | CT | Yes |
| 3416L0300X | Land Ambulance | — | NULL | — |

## Other

- **Enumeration date:** 09/19/2005
- **Last updated:** 02/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004084406 | — | CT |
| 01 | — | 590003585 | RAILROAD MEDICARE | — |
| 01 | — | 710C076P1CT01 | BLUE CROSS/BLUE SHIELD | — |
| 01 | — | CT0849 | HEALTHNET | — |