1861670770 NPI number — ACHILLES FOOT HEALTH CENTER, L.L.C.

Table of content: (NPI 1861670770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861670770 NPI number — ACHILLES FOOT HEALTH CENTER, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACHILLES FOOT HEALTH CENTER, L.L.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:
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:
1861670770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473-2343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-239-1119
Provider Business Mailing Address Fax Number:
203-234-1832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-239-1119
Provider Business Practice Location Address Fax Number:
203-234-1832
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DUROCHER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER OF PRACTICE
Authorized Official Telephone Number:
203-239-1119

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  00709 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 00709 , 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: 2704187 . This is a "UNTIED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004191277 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103244500 . This is a "FEDERAL DOL OWCP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CPD# 1392050 . This is a "AETNA - COVENTRY-FIRST HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 007090 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 11066538 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008003227 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO3120 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030000709CT01 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2110284 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1271789 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 60353065001 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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