1609864883 NPI number — EASTERN CONNECTICUT ENDOSCOPY CENTER LLC

Table of content: MR. MARK FRANCIS DZIK BSC PHARMACY (NPI 1396018248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609864883 NPI number — EASTERN CONNECTICUT ENDOSCOPY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN CONNECTICUT ENDOSCOPY CENTER LLC
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:
1609864883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1A BURTON HILLS BLVD # L&C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-240-3820
Provider Business Mailing Address Fax Number:
615-234-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 WAWECUS ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-2160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-886-7800
Provider Business Practice Location Address Fax Number:
860-886-7808
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SNODGRASS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0800X , with the licence number: 0295 , 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: 2373165 . This is a "AETNA PHMO POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351 . This is a "BCBS FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 490004614 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2373165 . This is a "AETNA PPO EPO NAP MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 765560 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351 . This is a "BCBS CT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351 . This is a "NBC NATIONAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: A2114853 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: IV9845 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2373165 . This is a "USHC AETNA US HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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