| South Park Inn | |
|
21 Grand St Hartford CT 06106-1541 | |
| (860) 550-7500 | |
| Not Available |
| Full Name | South Park Inn |
|---|---|
| Speciality | Clinic/Center |
| Location | 21 Grand St, Hartford, Connecticut |
| Authorized Official Name and Position | Alfreda Turner (PRESIDENT AND CEO) |
| Authorized Official Contact | 8605507500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Park Inn 75 Main St Hartford CT 06106-1806 Ph: (860) 550-7500 | South Park Inn 21 Grand St Hartford CT 06106-1541 Ph: (860) 550-7500 |
| NPI Number | 1003078734 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 12/05/2008 |
| Medicare PECOS PAC ID | 3870401078 |
|---|---|
| Medicare Enrollment ID | O20081029000515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003078734 | NPI | - | NPPES |
| 004236007 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 00000259 (Connecticut) | Primary |
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