Provider Demographics
NPI:1790743037
Name:BRISTOL-BURLINGTON HEALTH DISTRICT
Entity Type:Organization
Organization Name:BRISTOL-BURLINGTON HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOTES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPH, RS
Authorized Official - Phone:860-584-7682
Mailing Address - Street 1:240 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4682
Mailing Address - Country:US
Mailing Address - Phone:860-584-7682
Mailing Address - Fax:860-584-3814
Practice Address - Street 1:240 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4682
Practice Address - Country:US
Practice Address - Phone:860-584-7682
Practice Address - Fax:860-584-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT600000009Medicare ID - Type UnspecifiedMASS FLU CLINICS