Provider Demographics
NPI:1457655177
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 ; GENWORTH-LYNCHBURG
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 1:11001 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4757
Mailing Address - Country:US
Mailing Address - Phone:877-733-1710
Mailing Address - Fax:602-328-8410
Practice Address - Street 1:3100 ALBERT LANKFORD DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-4948
Practice Address - Country:US
Practice Address - Phone:434-948-5300
Practice Address - Fax:602-328-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center