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General NPI Number Information
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NPI Number | 1578106951
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Entity Type | Organization
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Legal Business Name | CONNECTICUT CHILDREN'S MEDICAL CENTER
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 282 WASHINGTON ST
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City | HARTFORD
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State | CT
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Zip | 06106-3322
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Country | US
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Telephone | 860-545-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 10 COLUMBUS BLVD
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City | HARTFORD
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State | CT
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Zip | 06106-1976
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Country | US
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Telephone | 860-837-6325
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Fax |
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Authorized Official
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Title or Position | SENIOR REV CYCLE ANALYST
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Name | RACHAEL JACOBSEN
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Credential |
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Telephone | 860-837-6325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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