1730311143 NPI number — COMMUNITY HEALTH CENTER INC

Table of content: (NPI 1730311143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730311143 NPI number — COMMUNITY HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CENTER 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:
1730311143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 MAIN ST 2ND FLOOR
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06457-2718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-347-6971
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06901-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-969-0802
Provider Business Practice Location Address Fax Number:
203-326-2990
Provider Enumeration Date:
08/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATRIE
Authorized Official First Name:
BAIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
860-347-6971

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  0455 , 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: 004236354 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004236338 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004236346 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".