1184639973 NPI number — THE GRIFFIN HOSPITAL

Table of content: MRS. AMY CALVERT CAMPBELL CFNP (NPI 1770876377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184639973 NPI number — THE GRIFFIN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GRIFFIN HOSPITAL
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:
1184639973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 DIVISION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418-1326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-732-7360
Provider Business Mailing Address Fax Number:
203-732-7386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06418-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-732-7360
Provider Business Practice Location Address Fax Number:
203-732-7386
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHARMEL
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT - CEO
Authorized Official Telephone Number:
203-732-7500

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X , with the licence number:  0034 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 0034 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 0034 , 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: 0034 , 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: 28M . This is a "BLUE CROSS MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0464667 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: H03255 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4025219 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 990352 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 028 . This is a "BLUE CROSS MEDICAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 28B . This is a "ANTHEM BLUE CROSS PSYCH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 000991 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4041927 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com