Organization
TOWN OF VERNON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LUDDECKE (CHIEF)
(860) 870-3634
Entity
Organization
Contact information
Practice address
14 PARK PL, VERNON, CT 06066-3291
(860) 871-7468
(860) 870-3539
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
—
004010229
—
CT
01
—
441590050
RAILROAD MEDICARE
CT
01
—
710C146A2CT01
BLUE CROSS/BLUE SHIELD
CT
01
—
CT8228
HEALTHNET
—
Enumeration date
02/09/2006
Last updated
09/21/2010
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