Provider Demographics
NPI:1437144284
Name:MADISON AMBULANCE ASSOCIATION INC
Entity type:Organization
Organization Name:MADISON AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEBURRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:203-245-5617
Mailing Address - Street 1:195 ROUTE 80
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1400
Mailing Address - Country:US
Mailing Address - Phone:860-663-3634
Mailing Address - Fax:860-663-3795
Practice Address - Street 1:9 OLD ROUTE 79
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2604
Practice Address - Country:US
Practice Address - Phone:203-245-9821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
CTC076P13416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0849OtherHEALTHNET
590003585OtherRAILROAD MEDICARE
CT004084406Medicaid
710C076P1CT01OtherBLUE CROSS/BLUE SHIELD
CT004084406Medicaid