Organization
HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS LLC
Active
Organization
HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BANCROFT VYE (VP ADMINISTRATION)
(860) 972-7858
Entity
Organization
Contact information
Practice address
65 MEMORIAL RD STE 430, WEST HARTFORD, CT 06107-4220
(860) 678-1050
Mailing address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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