1770659401 NPI number — GROVE HILL MEDICAL CENTER PC

Table of content: (NPI 1770659401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770659401 NPI number — GROVE HILL MEDICAL CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROVE HILL MEDICAL CENTER 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:
1770659401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/28/2014
NPI Reactivation Date:
01/28/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENSINGTON AVE
Provider Second Line Business Mailing Address:
GROVE HILL MEDICAL CENTER
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-801-6759
Provider Business Mailing Address Fax Number:
860-348-4873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
GROVE HILL MEDICAL CENTER
Provider Business Practice Location Address City Name:
SOUTHINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-628-4719
Provider Business Practice Location Address Fax Number:
860-348-4854
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GENOVESI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/PRES
Authorized Official Telephone Number:
860-224-6266

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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)





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