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Organization
THE MOHEGAN FIRE COMPANY INCORPORATED
Active
Organization
THE MOHEGAN FIRE COMPANY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY GAETANO (CHIEF)
(860) 848-3004
Entity
Organization
Contact information
Practice address
2029 NORWICH NEW LONDON TPKE, UNCASVILLE, CT 06382-1330
(860) 848-3004
Mailing address
2029 NORWICH NEW LONDON TPKE, UNCASVILLE, CT 06382-1330
(608) 483-0048
(860) 848-9038
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004136108
—
CT
01
—
590014884
RAILROAD MEDICARE
—
01
—
710C086B3CT01
BLUE CROSS/BLUE SHIELD
—
01
—
CU3445
HEALTHNET
—
Enumeration date
09/19/2005
Last updated
10/20/2022
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