Pequot Health Care

LBN: Mashantucket Pequot Tribal
Pequot Health Care is an health care organization with primary practice located at 1 Annie George Dr Bldg 1, Mashantucket CT 06338-3801. The organization recently has only one registered license in Suppliers / Mail Order Pharmacy, which is considered as the primary health care specialty. Mashantucket Pequot Tribal can be contacted via phone (860) 396-6438, or through Moldenhauer, Edward via phone (860) 396-2058.

Contact Information

Primary practice address
1 Annie George Dr Bldg 1 Mashantucket CT 06338-3801
Phone: (860) 396-6438
Fax: (800) 779-6329
Website:
Map and Directions
Authorized official contact:
Name: Moldenhauer, Edward
Phone: (860) 396-2058

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Mail Order Pharmacy 3336M0002X 285960015 Connecticut

Profile Details

NPI number 1578886461
LBN Legal business name Mashantucket Pequot Tribal
DBA Doing business as Pequot Health Care
Authorized official Moldenhauer, Edward
Entity Organization
Organization subpart 1 No
Enumeration date Mar 5th, 2010
Last updated Apr 1st, 2011 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578886461 NPPES
Other 0721820 NCPDP PROVIDER IDENTIFICATION NUMBER
MEDICAID 004129210 NCPDP PROVIDER IDENTIFICATION NUMBER

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