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
85 SEYMOUR ST STE 409, HARTFORD, CT 06106-5523
(860) 547-0616
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008085761
—
CT
Enumeration date
07/17/2019
Last updated
07/17/2019
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