Organization
MYSTIC RIVER AMBULANCE ASSOCIATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEO TODD MCDONNELL (PRESIDENT)
(860) 572-0283
Entity
Organization
Contact information
Practice address
237 SANDY HOLLOW RD, MYSTIC, CT 06355-1617
(860) 572-0283
Mailing address
PO BOX 165, BRANFORD, CT 06405-0165
(860) 452-4500
(860) 452-4430
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004116093
—
CT
01
—
590006767
RAILROAD MEDICARE
—
01
—
710C137B1CT01
BLUE CROSS/BLUE SHIELD
—
01
—
CT0795
HEALTHNET
—
Enumeration date
09/20/2005
Last updated
11/18/2025
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