Organization
HOSPITAL INTERNISTS OF BRISTOL, LLC
Active
Organization
HOSPITAL INTERNISTS OF BRISTOL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH TILLMAN MD (MEDICAL DIRECTOR)
(860) 585-3313
Entity
Organization
Contact information
Practice address
41 BREWSTER RD, BRISTOL, CT 06010-5161
(860) 585-3313
(860) 585-3500
Mailing address
41 BREWSTER RD, BRISTOL, CT 06010-5161
(860) 585-3313
(860) 585-3500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03918
GROUP MEDICARE
CT
Enumeration date
10/03/2007
Last updated
01/22/2009
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