Provider Demographics
NPI:1568799278
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; BATH IRONWORKS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
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 1:700 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2574
Practice Address - Country:US
Practice Address - Phone:207-442-4939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center