Organization
MOHEGAN TRIBE OF INDIANS OF CONNECTICUT
Active
Other names
Mohegan Tribal Council
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY T GENTILE (AUTHORIZED AGENT)
(860) 257-9201
Entity
Organization
Contact information
Practice address
13 CROW HILL RD, UNCASVILLE, CT 06382-1118
(860) 862-6110
(860) 862-6140
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(860) 257-9201
(860) 721-6360
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
C086P1
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004185428
—
CT
01
—
590012782
RAILROAD MEDICARE
—
Enumeration date
10/26/2005
Last updated
06/19/2019
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