Basic Information
| Provider Information | |||||||||
| NPI: | 1386731271 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTBROOK AMBULANCE ASSOCIATION, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 682 | ||||||||
| Address2: | |||||||||
| City: | WESTBROOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064980682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606633634 | ||||||||
| FaxNumber: | 8606633795 | ||||||||
| Practice Location | |||||||||
| Address1: | 1316 BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | WESTBROOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064981972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606633634 | ||||||||
| FaxNumber: | 8606633795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CASTLEVETRO | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8606633634 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | E4515 | CT | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 732661 | 01 | CT | CONNECTICARE | OTHER | CT7461 | 01 | CT | HEALTHNET | OTHER |