1275560856 NPI number — SHARON EMERGENCY MEDICINE PC

Table of content: (NPI 1275560856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275560856 NPI number — SHARON EMERGENCY MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON EMERGENCY MEDICINE PC
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:
1275560856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 753
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-898-7138
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 HOSPITAL HILL DRIVE
Provider Second Line Business Practice Location Address:
ER DEPARTMENT
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-795-5820
Provider Business Practice Location Address Fax Number:
616-975-9728
Provider Enumeration Date:
06/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHIN
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
860-364-4141

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: A3231004 . This is a "OXFORD HEALTH INSURANCE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0114103630 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBE202CT01 . This is a "BCBS OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".