1356433486 NPI number — WINDSOR LOCKS MEDICAL CENTER, LLP

Table of content: (NPI 1356433486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356433486 NPI number — WINDSOR LOCKS MEDICAL CENTER, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDSOR LOCKS MEDICAL CENTER, LLP
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:
1356433486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 OLD COUNTY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR LOCKS
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-627-0161
Provider Business Mailing Address Fax Number:
860-292-1327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 OLD COUNTY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR LOCKS
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-627-0161
Provider Business Practice Location Address Fax Number:
860-292-1327
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPECTOR
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
860-627-0161

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X , with the licence number:  026154 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 026154 , 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)

  • Identifier: HEALTHNET . This is a "OV1001" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".