1003882812 NPI number — TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC

Table of content: (NPI 1003882812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003882812 NPI number — TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION 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:
6
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:
1003882812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ASYLUM AVE STE 4309A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-1325
Provider Business Mailing Address Fax Number:
860-714-8078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 WOODLAND ST
Provider Second Line Business Practice Location Address:
SAINT FRANCIS MEDICAL GROUP INC.
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-1325
Provider Business Practice Location Address Fax Number:
860-714-8078
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
860-714-4396

Provider Taxonomy Codes

  • 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: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0000X ; 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: 207RX0202X ; 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: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; 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: 004255221 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008040858 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004179059 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004255742 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008041399 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008060133 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004197621 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008049887 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008057685 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004179067 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004254504 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008026230 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008041385 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008041438 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004208957 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004217619 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008004638 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008035513 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004197689 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008026251 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com