Healthcare Provider Details

I. General information

NPI: 1215947387
Provider Name (Legal Business Name): CONNECTICUT CHILDREN'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-8557
  • Fax:
Mailing address:
  • Phone: 860-837-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number2-CH
License Number StateCT

VIII. Authorized Official

Name: RACHAEL JACOBSEN
Title or Position: REVENUE CYCLE SYSTEMS ANALYSTS
Credential:
Phone: 860-837-6325