=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073099339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUTMEG MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2018
-----------------------------------------------------
Last Update Date | 11/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 YORKSHIRE WAY
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06013-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-463-4000
-----------------------------------------------------
Fax | 860-675-3044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 YORKSHIRE WAY
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06013-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-930-7875
-----------------------------------------------------
Fax | 860-507-7576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. STEVEN J. ORLOWSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-930-7875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------