Provider Demographics
NPI:1306413844
Name:HARTFORD HOSPITAL
Entity Type:Organization
Organization Name:HARTFORD HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP, FINANCE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-545-0585
Mailing Address - Street 1:79 RETREAT AVENUE
Mailing Address - Street 2:HARTFORD HOSPITAL DEPT OF DENTISTRY
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-972-2700
Mailing Address - Fax:
Practice Address - Street 1:79 RETREAT AVENUE
Practice Address - Street 2:HARTFORD HOSPITAL DEPT OF DENTISTRY
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-972-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies