MC DIAGNOSTIC OF CONNECTICUT, P.C. - NPI NUMBER 1386821932

Summary

Provider Name: MC DIAGNOSTIC OF CONNECTICUT, P.C.

NPI Number: 1386821932

Clasification: Nurse Practitioner (363LF0000X)

Specialization: Family

Address:
323 CROMWELL AVE
ROCKY HILL, CT
ZIP 06067

Phone Number: (866) 389-2727



Detailed Information

MC DIAGNOSTIC OF CONNECTICUT, P.C. is a family nurse practitioner in Rocky Hill, CT. The assigned NPI number for this provider is 1386821932 and is registered as an organization entity type and is a multiple single specialty group.

The provider's business address is:

323 CROMWELL AVE
ROCKY HILL, CT
ZIP 06067-801
Phone: (866) 389-2727
Fax: (401) 406-3539

The provider's authorized official is Deborah J Pincince .
The authorized official title is Administrator and has the following contact phone number (866) 389-2727.

The enumeration date for this NPI number is 1/25/2008 and was last updated on 10/30/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363LF0000X Nurse Practitioner Family Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 DO1751 OTHER CT MEDICARE RAILROAD
2 CO3843 MEDICARE PIN CT

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1386821932 The 10-position telephone number of the authorized official.
2 Entity Type Code 2 Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name MC DIAGNOSTIC OF CONNECTICUT, P.C. Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
5 Provider First Line Business Practice Location Address 323 CROMWELL AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name ROCKY HILL The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name CT The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 060671801 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 8663892727 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 4014063539 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 1/25/2008 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 10/30/2014 The date that a record was last updated or changed.
14 Authorized Official Last Name PINCINCE The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name DEBORAH The first name of the authorized official.
16 Authorized Official Middle Name J The middle name of the authorized official.
17 Authorized Official Title or Position ADMINISTRATOR The title or position of the authorized official.
18 Authorized Official Telephone Number 8663892727 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 363LF0000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 DO1751 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
22 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier State 1 CT
24 Other Provider Identifier Issuer 1 MEDICARE RAILROAD
25 Other Provider Identifier 2 CO3843 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier State 2 CT
28 Is Organization Subpart N
29 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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