1609084581 NPI number — BRISTOL HOSPITAL MULTI-SPECIALTY GROUP, INC.

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 1609084581 NPI number — BRISTOL HOSPITAL MULTI-SPECIALTY GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRISTOL HOSPITAL MULTI-SPECIALTY GROUP, 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:
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:
1609084581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2828
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06011-2828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-585-3906
Provider Business Mailing Address Fax Number:
860-585-3907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 NEWELL RD STE D21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06010-5128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-585-3295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEANEY
Authorized Official First Name:
CHRIS ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-585-3041

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004269959 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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