TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC

Provider Demographics

• NPI: 1003882812
• Name: TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC
• Entity Type: Organization
• Organization Name: TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC
• Other - Org Name: TRINITY HEALTH OF NEW ENGLAND MEDICAL GROUP
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: INTERIM PRESIDENT
• Authorized Official - First Name: CARLOS
• Authorized Official - Last Name: MARTINS
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 413-523-0816
• Mailing Address - Street 1: 1000 ASYLUM AVE STE 4309A
• Mailing Address - City: HARTFORD
• Mailing Address - State: CT
• Mailing Address - Zip Code: 06105-1704
• Mailing Address - Country: US
• Mailing Address - Phone: 860-714-1325
• Mailing Address - Fax: 860-714-8078
• Practice Address - Street 1: 114 WOODLAND ST
• Practice Address - Street 2: SAINT FRANCIS MEDICAL GROUP INC.
• Practice Address - City: HARTFORD
• Practice Address - State: CT
• Practice Address - Zip Code: 06105-1208
• Practice Address - Country: US
• Practice Address - Phone: 860-714-1325
• Practice Address - Fax: 860-714-8078
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: TRINITY HEALTH OF NEW ENGLAND CORPORATION INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-02-23
• Last Update Date: 2019-09-17

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RE0101X	Allopathic & Osteopathic Physicians	Internal Medicine	Endocrinology, Diabetes & Metabolism	Group - Multi-Specialty
No	207RG0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Geriatric Medicine	Group - Multi-Specialty
No	207RH0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology	Group - Multi-Specialty
No	207RH0003X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology & Oncology	Group - Multi-Specialty
No	207RI0200X	Allopathic & Osteopathic Physicians	Internal Medicine	Infectious Disease	Group - Multi-Specialty
No	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine	Pulmonary Disease	Group - Multi-Specialty
No	207RR0500X	Allopathic & Osteopathic Physicians	Internal Medicine	Rheumatology	Group - Multi-Specialty
No	207RX0202X	Allopathic & Osteopathic Physicians	Internal Medicine	Medical Oncology	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207VM0101X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Maternal & Fetal Medicine	Group - Multi-Specialty
No	207VX0201X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Gynecologic Oncology	Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CT	004144474	Medicaid
CT	004179067	Medicaid
CT	004254504	Medicaid
CT	004255742	Medicaid
CT	008041399	Medicaid
CT	008050163	Medicaid
CT	008057685	Medicaid
CT	004255221	Medicaid
CT	008026230	Medicaid
CT	008041438	Medicaid
CT	008041543	Medicaid
CT	008059165	Medicaid
CT	008004638	Medicaid
CT	008049989	Medicaid
CT	004179059	Medicaid
CT	008026251	Medicaid
CT	008035513	Medicaid
CT	008049887	Medicaid
CT	008060133	Medicaid
CT	004208957	Medicaid
CT	008030966	Medicaid
CT	008040858	Medicaid
CT	004197689	Medicaid
CT	004217619	Medicaid
CT	008040926	Medicaid
CT	008041385	Medicaid
CT	008041511	Medicaid
CT	004197621	Medicaid
CT	008026223	Medicaid
CT	008040940	Medicaid
CT	008059165	Medicaid