1265860373 NPI number — WINDHAM COMMUNITY MEMORIAL HOSPITAL

Table of content: ASHESHA MECHINENI MD, FACP (NPI 1659784817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265860373 NPI number — WINDHAM COMMUNITY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDHAM COMMUNITY MEMORIAL HOSPITAL
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:
1265860373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 MANSFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIMANTIC
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06226-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-456-6821
Provider Business Mailing Address Fax Number:
860-456-6959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 TUCKIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH WINDHAM
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06256-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-465-2610
Provider Business Practice Location Address Fax Number:
860-465-2638
Provider Enumeration Date:
10/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MACKIE
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
860-456-6821

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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