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General NPI Number Information
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NPI Number | 1467442863
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Entity Type | Organization
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Legal Business Name | MOHEGAN TRIBE OF INDIANS OF CONNECTICUT
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 13 CROW HILL RD
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City | UNCASVILLE
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State | CT
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Zip | 06382-1118
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Country | US
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Telephone | 860-862-6110
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Fax | 860-862-6140
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Provider Business Mailing Address
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Address Line | PO BOX 290184
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City | WETHERSFIELD
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State | CT
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Zip | 06129-0184
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Country | US
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Telephone | 860-257-9201
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Fax | 860-721-6360
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MS. MARY T GENTILE
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Credential |
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Telephone | 860-257-9201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | C086P1
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License Number State |
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