Provider Demographics
NPI:1043429806
Name:BRISTOL HOSPITAL MULTI-SPECIALTY GROUP, INC.
Entity Type:Organization
Organization Name:BRISTOL HOSPITAL MULTI-SPECIALTY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MHA, FACHE
Authorized Official - Phone:860-585-3041
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-2828
Mailing Address - Country:US
Mailing Address - Phone:860-585-3906
Mailing Address - Fax:860-585-3907
Practice Address - Street 1:25 NEWELL RD STE E31
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5140
Practice Address - Country:US
Practice Address - Phone:860-308-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004269537Medicaid
CT004269537Medicaid