Healthcare Provider Details

I. General information

NPI: 1407256415
Provider Name (Legal Business Name): SAINT FRANCIS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 2120
HARTFORD CT
06105-1770
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 2103
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-4000
  • Fax: 860-527-6985
Mailing address:
  • Phone: 860-714-5058
  • Fax: 860-714-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: SCOTT ELLNER
Title or Position: DO/PRESIDENT
Credential: DO
Phone: 860-714-5237