# ROY B PETTENGILL AMB ASSOC

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

## Provider details

- **NPI number:** 1750379293
- **Authorized official:** LORI A TARKA (PRESIDENT)
- **Authorized official phone:** (860) 402-5899

## Contact information

- **Practice address:** 7 HEBRON RD, MARLBOROUGH, CT 06447-1202
- **Practice address phone:** (860) 295-6219
- **Practice address fax:** (860) 295-0604
- **Mailing address:** PO BOX 165, BRANFORD, CT 06405-0165
- **Mailing address phone:** (860) 663-3634
- **Mailing address fax:** (860) 452-4430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | C079B1 | CT | Yes |

## Other

- **Enumeration date:** 10/10/2005
- **Last updated:** 11/04/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004224565 | — | CT |