=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467517235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WILLIAM W BACKUS HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 04/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 WASHINGTON ST
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-889-8331
-----------------------------------------------------
Fax | 860-892-6983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 WASHINGTON ST
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-889-8331
-----------------------------------------------------
Fax | 860-892-6983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL VP OF FINANCE
-----------------------------------------------------
Name | MR. ANTHONY MASTROIANNI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-889-8331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number | 0037
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 0037
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------