1336564673 NPI number — CONNECTICUT GENERAL LIFE INSURANCE COMPANY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336564673 NPI number — CONNECTICUT GENERAL LIFE INSURANCE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
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:
1336564673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25500 N NORTERRA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-733-1710
Provider Business Mailing Address Fax Number:
623-277-1091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 OG SKINNER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31833-1771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-634-3131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
POPKO
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL SENIOR DIRECTOR
Authorized Official Telephone Number:
412-747-4128

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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