Provider Demographics
NPI:1346651015
Name:UNIVERSITY OF CONNECTICUT HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CONNECTICUT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PROGRAM COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-679-3004
Mailing Address - Street 1:837 VENETIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6327
Mailing Address - Country:US
Mailing Address - Phone:631-902-2444
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:06030-1720
Practice Address - Country:US
Practice Address - Phone:860-679-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty