1023191467 NPI number — WINDHAM COMMUNITY MEMORIAL HOSPITAL, INC.

Table of content: (NPI 1023191467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023191467 NPI number — WINDHAM COMMUNITY MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDHAM COMMUNITY MEMORIAL 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:
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:
1023191467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 MANSFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIMANTIC
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06226-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-425-8755
Provider Business Mailing Address Fax Number:
860-885-6492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 MANSFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIMANTIC
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06226-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-456-6752
Provider Business Practice Location Address Fax Number:
203-265-4557
Provider Enumeration Date:
10/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACKIE
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
860-425-8755

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X , with the licence number: 0061 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0002X , with the licence number: 0061 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 0061 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , with the licence number: 0061 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 0061 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LN0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004025110 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: H055902 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004041828 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0014138 . This is a "AETNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 0465969015 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: TRICARE . This is a "35175" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: H01661 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 022 . This is a "BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 115714300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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