=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184615114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WATERBURY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 09/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 ROBBINS ST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-573-7280
-----------------------------------------------------
Fax | 203-573-7325
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 ROBBINS ST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-573-7280
-----------------------------------------------------
Fax | 203-573-7325
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MS. COLLEEN M SCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-573-7280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 0060
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------