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General NPI Number Information
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NPI Number | 1932123569
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Entity Type | Organization
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Legal Business Name | JOHNSON MEMORIAL HOSPITAL, INC.
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 201 CHESTNUT HILL ROAD
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-0860
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Country | US
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Telephone | 860-684-4251
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Fax |
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Provider Business Mailing Address
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Address Line | 201 CHESTNUT HILL RD
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-4005
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Country | US
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Telephone | 860-684-4251
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT ROOSE
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Credential |
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Telephone | 413-748-9335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0072
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 0072
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License Number State | CT
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