Provider Demographics
NPI:1295022234
Name:CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)
Entity Type:Organization
Organization Name:CONNECTICUT GENERAL LIFE INSURANCE COMPANY (CGLIC)
Other - Org Name:CIGNA ONSITE HEALTH, LLC; REYNOLDS & REYNOLDS - DAYTON
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 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:877-733-1710
Mailing Address - Fax:602-328-8410
Practice Address - Street 1:1 REYNOLDS WAY
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45430-1586
Practice Address - Country:US
Practice Address - Phone:937-485-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center