Healthcare Provider Details

I. General information

NPI: 1790421741
Provider Name (Legal Business Name): IVX HEALTH OF CONNECTICUT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 HEBRON AVE UNIT B
GLASTONBURY CT
06033-4223
US

IV. Provider business mailing address

214 CENTERVIEW DR STE 250
BRENTWOOD TN
37027-3248
US

V. Phone/Fax

Practice location:
  • Phone: 860-996-8117
  • Fax:
Mailing address:
  • Phone: 615-610-3733
  • Fax: 844-206-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SEIBELS
Title or Position: CFO
Credential:
Phone: 615-610-3727