1538485875 NPI number — CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)

Table of content: (NPI 1538485875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538485875 NPI number — CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)
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:
CIGNA ONSITE HEALTH, LLC; PBSO; PALM BEACH SHERIFF OFFICE
Provider Other Organization Name Type Code:
5
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:
1538485875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11001 N BLACK CANYON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85029-4757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-733-1710
Provider Business Mailing Address Fax Number:
602-328-8410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 CENTRE PARK WEST DR
Provider Second Line Business Practice Location Address:
STE 175
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33409-6453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-242-3009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SLICE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
602-371-2971

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com