Provider Demographics
NPI:1093960536
Name:CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)
Entity Type:Organization
Organization Name:CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)
Other - Org Name:CIGNA MEDICAL SERVICES, LLC ; CIGNA ONSITE HEALTH, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SLICE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:602-371-2971
Mailing Address - Street 1:11001 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4757
Mailing Address - Country:US
Mailing Address - Phone:877-733-1710
Mailing Address - Fax:602-328-8410
Practice Address - Street 1:900 COTTAGE GROVE RD
Practice Address - Street 2:LLHEA
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06152-0001
Practice Address - Country:US
Practice Address - Phone:860-226-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center