1932138138 NPI number — SAINT RAPHAEL FACULTY PHYSICIANS

Table of content: (NPI 1932138138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932138138 NPI number — SAINT RAPHAEL FACULTY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT RAPHAEL FACULTY PHYSICIANS
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:
1932138138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1951
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRATTLEBORO
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05302-1951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-595-0531
Provider Business Mailing Address Fax Number:
508-829-5367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 CHAPEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-789-5946
Provider Business Practice Location Address Fax Number:
203-867-5287
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCMANUS
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
203-789-4059

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 008002476 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008002619 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008003155 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008002615 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008002212 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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