Provider Demographics
NPI: | 1932468360 |
---|---|
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; YOROZU |
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: | 623-277-2351 |
Mailing Address - Street 1: | 25500 N NORTERRA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85085-8200 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 877-733-1710 |
Mailing Address - Fax: | 623-277-2335 |
Practice Address - Street 1: | 395 MT. VIEW |
Practice Address - Street 2: | INDUSTRIAL DRIVE |
Practice Address - City: | MORRISON |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37357 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-328-8400 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-05-04 |
Last Update Date: | 2012-05-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |