Basic Information
| Provider Information | |||||||||
| NPI: | 1518060334 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUNTER'S AMBULANCE SERVICE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HUNTER'S MIDDLESEX AMBULANCE SERVICE INC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 SILAS DEANE HIGHWAY | ||||||||
| Address2: | 1ST FLOOR, SUITE 102 | ||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609727145 | ||||||||
| FaxNumber: | 8609727040 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 W. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064512708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032353369 | ||||||||
| FaxNumber: | 2035145122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | HAVICAN | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CENTRAL REGION PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8602245723 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343800000X | N | Transportation Services | Secured Medical Transport (VAN) | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 008041368 | 01 | CT | CHAIRCAR | OTHER |