| City Of Hartford | |
|
131 Coventry St. Hartford CT 06112-1548 | |
| (860) 757-4830 | |
| (860) 722-6826 |
| Full Name | City Of Hartford |
|---|---|
| Speciality | Clinic/Center |
| Location | 131 Coventry St., Hartford, Connecticut |
| Authorized Official Name and Position | Ebony Elizabeth Jackson-shaheed (DIRECTOR OF HEALTH) |
| Authorized Official Contact | 8607579311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| City Of Hartford 131 Coventry St. Hartford CT 06112-1548 Ph: (860) 757-4846 | City Of Hartford 131 Coventry St. Hartford CT 06112-1548 Ph: (860) 757-4830 |
| NPI Number | 1700133527 |
|---|---|
| Provider Enumeration Date | 08/10/2012 |
| Last Update Date | 07/28/2023 |
| Medicare PECOS PAC ID | 5991921124 |
|---|---|
| Medicare Enrollment ID | O20140724001851 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700133527 | NPI | - | NPPES |
| 008042506 | Medicaid | CT |
| Provider Name | Lydia R Roldan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548280175 PECOS PAC ID: 3678706801 Enrollment ID: I20140423002374 |
| Provider Name | Seja Joyce Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720270119 PECOS PAC ID: 3971857947 Enrollment ID: I20181109000398 |
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