Healthcare Provider Details

I. General information

NPI: 1467517235
Provider Name (Legal Business Name): THE WILLIAM W BACKUS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

IV. Provider business mailing address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-8331
  • Fax: 860-892-6983
Mailing address:
  • Phone: 860-889-8331
  • Fax: 860-892-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number0037
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0037
License Number StateCT

VIII. Authorized Official

Name: MR. ANTHONY MASTROIANNI
Title or Position: REGIONAL VP OF FINANCE
Credential:
Phone: 860-889-8331