Organization
TOWN OF PLYMOUTH VOLUNTEER AMBULANCE CORPS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANI JOHNSON (PRESIDENT)
(860) 584-5370
Entity
Organization
Contact information
Practice address
191 MAIN ST, TERRYVILLE, CT 06786-6219
(860) 584-5370
(860) 589-8554
Mailing address
269 MAIN ST, CROMWELL, CT 06416-2302
(860) 638-1800
(860) 638-1802
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004194817
—
CT
01
—
710C111A2CT01
BLUE CROSS/BLUE SHIELD
CT
01
—
CU9362
HEALTHNET
—
Enumeration date
02/09/2006
Last updated
09/21/2010
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