1760408793 NPI number — MRS. FRANCES R PHELPS RPT

Table of content: MRS. FRANCES R PHELPS RPT (NPI 1760408793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760408793 NPI number — MRS. FRANCES R PHELPS RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELPS
Provider First Name:
FRANCES
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760408793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 B FARMINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-693-2225
Provider Business Mailing Address Fax Number:
860-236-2216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 B FARMINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-693-2225
Provider Business Practice Location Address Fax Number:
860-236-2216
Provider Enumeration Date:
07/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  000513 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080000513CT01 . This is a "ANTHEM/BCBS OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2928062 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0V1706 . This is a "ACS HEALTH NET" identifier . This identifiers is of the category "OTHER".