1760690101 NPI number — SAINT FRANCIS CARE MEDICAL GROUP, P.C.

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 1760690101 NPI number — SAINT FRANCIS CARE MEDICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT FRANCIS CARE MEDICAL GROUP, P.C.
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:
1760690101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ASYLUM AVE
Provider Second Line Business Mailing Address:
SUITE 4309
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-1325
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 WOODLAND ST
Provider Second Line Business Practice Location Address:
SAINT FRANCIS CARE MEDICAL GROUP PC
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-979-1880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHERA
Authorized Official First Name:
SURENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
860-714-4361

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004211215 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8413924000 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004156437 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008025819 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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