Provider Demographics
NPI:1740387182
Name:WESTERN CONNECTICUT HEALTH NETWORK AFFILIATES, INC.
Entity Type:Organization
Organization Name:WESTERN CONNECTICUT HEALTH NETWORK AFFILIATES, INC.
Other - Org Name:WESTERN CONNECTICUT IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-739-7701
Mailing Address - Street 1:24 HOSPITAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-894-1444
Mailing Address - Fax:203-739-8199
Practice Address - Street 1:901 ETHAN ALLEN HIGHWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877
Practice Address - Country:US
Practice Address - Phone:203-894-1444
Practice Address - Fax:203-739-8199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN RN CONNECTICUT HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT470000033Medicare PIN
470000033Medicare PIN