Organization
STATE OF CONNECTICUT
Active
Other names
John Dempsey Hospital-Hemophilia Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN BIANCAMANO (CHIEF FINANCIAL OFFICER)
(860) 679-1145
Entity
Organization
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-5355
(860) 679-2916
(860) 679-3071
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-5355
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
00065
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-0036
MEDICARE ID-TYPE UNSPECIFIED
CT
05
—
4041968
—
CT
01
—
XXXXXXXXX
TRICARE/CHAMPUS
CT
Enumeration date
11/08/2012
Last updated
11/08/2012
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