Provider Demographics
NPI:1871095851
Name:STATE OF CONNECTICUT
Entity type:Organization
Organization Name:STATE OF CONNECTICUT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR OF HOSPITAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-679-7835
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-7835
Mailing Address - Fax:
Practice Address - Street 1:850 BOLTON RD UNIT 1271
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1271
Practice Address - Country:US
Practice Address - Phone:860-486-3108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF CONNECTICUT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-06
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)