Provider Demographics
NPI:1215363700
Name:CAPITAL AREA HEALTH CONSORTIUM
Entity Type:Organization
Organization Name:CAPITAL AREA HEALTH CONSORTIUM
Other - Org Name:INTERNAL MEDICINE RESIDENCY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DESIGNATED INSTITUTION OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-679-2147
Mailing Address - Street 1:2 PARK PL
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-2437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital