Provider Demographics
| NPI: | 1134282460 |
|---|---|
| Name: | HARTFORD CLINICAL ASSOCIATES, P.C. |
| Entity Type: | Organization |
| Organization Name: | HARTFORD CLINICAL ASSOCIATES, P.C. |
| Other - Org Name: | HARTFORD SPECIALISTS |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | VICE PRESIDENT, OPERATIONS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | RITA |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | PARISI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 860-524-4506 |
| Mailing Address - Street 1: | 17 TALCOTT NOTCH RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FARMINGTON |
| Mailing Address - State: | CT |
| Mailing Address - Zip Code: | 06032-1818 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 860-524-2626 |
| Mailing Address - Fax: | 860-677-5029 |
| Practice Address - Street 1: | 85 SEYMOUR ST |
| Practice Address - Street 2: | SUITE 415 |
| Practice Address - City: | HARTFORD |
| Practice Address - State: | CT |
| Practice Address - Zip Code: | 06106-5501 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 860-493-2511 |
| Practice Address - Fax: | 860-549-1476 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | HARTFORD CLINICAL ASSOCIATES, PC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-12-18 |
| Last Update Date: | 2012-08-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | Group - Multi-Specialty |
| No | 2082S0105X | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | Group - Multi-Specialty |
| No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 2088P0231X | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | Group - Multi-Specialty |
| No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 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 | 008034734 | Medicaid | |
| CT | 008034758 | Medicaid | |
| CT | 004080545 | Medicaid | |
| C00177 | Medicare ID - Type Unspecified | GROUP MEDICARE NUMBER |
