Organization
HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BANCROFT VYE (VP OF ADMINISTRATION)
(860) 972-7858
Entity
Organization
Contact information
Practice address
85 POHEGANUT DRIVE, SUITE 3, GROTON, CT 06340-3252
(860) 437-3737
Mailing address
1290 SILAS DEANE HWY, HHC CVO, WETHERSFIELD, CT 06109
(860) 972-9033
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
02/10/2020
Last updated
02/10/2020
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