1760426969 NPI number — SAINT MARY'S HOSPITAL, INC.

Table of content: (NPI 1760426969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760426969 NPI number — SAINT MARY'S HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT MARY'S HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. MARY'S HOSPITAL CORPORATION
Provider Other Organization Name Type Code:
4
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:
1760426969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06706-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-709-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06706-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-709-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
860-714-4396

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0055 , 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: 004025060 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: H01112 . This is a "OXFORD PROV NO." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 019 . This is a "ANTHEM BLUE CROSS BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: IR0800 . This is a "HEALTHNET PROV NO." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004041760 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com