# MYSTIC RIVER AMBULANCE ASSOCIATION, INC

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

## Provider details

- **NPI number:** 1699760249
- **Authorized official:** LEO TODD MCDONNELL (PRESIDENT)
- **Authorized official phone:** (860) 572-0283

## Contact information

- **Practice address:** 237 SANDY HOLLOW RD, MYSTIC, CT 06355-1617
- **Practice address phone:** (860) 572-0283
- **Mailing address:** PO BOX 165, BRANFORD, CT 06405-0165
- **Mailing address phone:** (860) 452-4500
- **Mailing address fax:** (860) 452-4430

## Taxonomy

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

## Other

- **Enumeration date:** 09/20/2005
- **Last updated:** 11/18/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004116093 | — | CT |
| 01 | — | 590006767 | RAILROAD MEDICARE | — |
| 01 | — | 710C137B1CT01 | BLUE CROSS/BLUE SHIELD | — |
| 01 | — | CT0795 | HEALTHNET | — |