# THE MOHEGAN FIRE COMPANY INCORPORATED

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

## Provider details

- **NPI number:** 1679568323
- **Authorized official:** COREY GAETANO (CHIEF)
- **Authorized official phone:** (860) 848-3004

## Contact information

- **Practice address:** 2029 NORWICH NEW LONDON TPKE, UNCASVILLE, CT 06382-1330
- **Practice address phone:** (860) 848-3004
- **Mailing address:** 2029 NORWICH NEW LONDON TPKE, UNCASVILLE, CT 06382-1330
- **Mailing address phone:** (608) 483-0048
- **Mailing address fax:** (860) 848-9038

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 09/19/2005
- **Last updated:** 10/20/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004136108 | — | CT |
| 01 | — | 590014884 | RAILROAD MEDICARE | — |
| 01 | — | 710C086B3CT01 | BLUE CROSS/BLUE SHIELD | — |
| 01 | — | CU3445 | HEALTHNET | — |