Provider Demographics
NPI:1619901642
Name:BRISTOL HOSPITAL INCORPORATED
Entity Type:Organization
Organization Name:BRISTOL HOSPITAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BARWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-585-3222
Mailing Address - Street 1:41 BREWSTER RD
Mailing Address - Street 2:PO BOX 977
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-0977
Mailing Address - Country:US
Mailing Address - Phone:860-585-3223
Mailing Address - Fax:860-585-3179
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06011-0977
Practice Address - Country:US
Practice Address - Phone:860-585-3357
Practice Address - Fax:860-585-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4025193Medicaid
CTH04722OtherOXFORD
CT996294OtherCONNECTICARE
CT4041901Medicaid
CT002OtherBLUE CROSS
CT63122OtherAETNA US
CTC001869OtherCHAMPUS
CTI70013OtherHEALTHNET
CTI70013OtherHEALTHNET
CT070029Medicare Oscar/Certification