Healthcare Provider Details

I. General information

NPI: 1396913554
Provider Name (Legal Business Name): PROHEALTH BONE DENSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FARM SPRINGS RD
FARMINGTON CT
06032-2573
US

IV. Provider business mailing address

4 FARM SPRINGS RD
FARMINGTON CT
06032-2573
US

V. Phone/Fax

Practice location:
  • Phone: 860-284-5200
  • Fax:
Mailing address:
  • Phone: 860-284-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM BARNARD
Title or Position: VP OF ANCILLARY SERVICES
Credential:
Phone: 860-284-5200