1063413011 NPI number — UNITED SERVICES INC

Table of content: (NPI 1063413011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063413011 NPI number — UNITED SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED SERVICES 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:
1063413011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 839
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06241-0839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-774-2020
Provider Business Mailing Address Fax Number:
860-774-0826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06241-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-774-2020
Provider Business Practice Location Address Fax Number:
860-774-0826
Provider Enumeration Date:
08/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANNING
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
860-774-2020

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  CPA-39 , 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: 77ABH0043CT01 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004040564 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172895 . This is a "MHN" identifier . This identifiers is of the category "OTHER".