MOHEGAN TRIBE OF INDIANS OF CT (NPI# 1326313677) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326313677 |
| Entity Type | Organization |
| Organization Name | MOHEGAN TRIBE OF INDIANS OF CT |
| Other Organization Name | MOHEGAN PHARMACY |
| Practice Address |
67 Sandy Desert Rd Uncasville CT 06382-1111 |
| Practice Telephone | 8556644679 |
| Practice Fax Number | 8608629099 |
| Mailing Telephone | 8556644679 |
| Mailing Fax Number | 8608629099 |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2019-06-18 |
| Authorized Official Name | DEBRA MAXEINER (DEPUTY CHIEF OF STAFF, OPS&ADMIN) |
| Authorized Official Telephone | 8608626343 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | PCY.0001934 | CT | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 22-102271 | KS | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | NRX0000432 | DC | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | OSP.0006230 | CO | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2013044792 | MO | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 14964/7.1 | MS | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | PHY.007550-NR | LA | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | PHNR001180 | GA | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | PH26952 | FL | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 54.018477 | IL | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | PHA-MOP-LI | MT | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | PMP-959 | HI | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | NRP-1530 | CA | Suppliers |
| N | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | MO40001384 | ME | Suppliers |
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 114286 | AL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2135247 | 01 |
| Other Name | Type Code |
|---|---|
| Mohegan Pharmacy | Doing Business As Name - Organization |
| Street Address |
67 SANDY DESERT RD |
| City | UNCASVILLE |
| State | CT |
| Zip Code | 06382-1111 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437379005 | Walgreen Co. | Pharmacy | 67 Sandy Desert Rd, Uncasville, CT 06382-1111 | 2007-04-26 |
| 1912273194 | Khristine S Lariviere | Pharmacist | 67 Sandy Desert Rd, Uncasville, CT 06382-1111 | 2012-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235336934 | Saqib Inayatullah | Internal Medicine | 88 Norwich New London Tpke Ste 2, Uncasville, CT 06382 | 2007-06-27 |
| 1730301011 | Kelly Susan Roberge | Marriage & Family Therapist | 20 Maple Ave., Uncasville, CT 06382 | 2007-05-03 |
| 1427172543 | Madeleine Sherwood Lefker | Speech-Language Pathologist | 303 Norwich New London Tpke., Uncasville, CT 06382 | 2007-03-16 |
| 1245385426 | Community Therapeutix PC | Acupuncturist | 88 Norwich New London Turnpike, Suite 1, Uncasville, CT 06382 | 2007-01-25 |
| 1619031796 | Southeastern Ct Nephrology Assoc PC | Internal Medicine | 88 Norwich New London Tpk, Suite 2, Uncasville, CT 06382 | 2006-12-21 |
| 1598833725 | Orchard Grove Specialty Care Center | Nursing Facility/Intermediate Care Facility | 5 Richard Brown Drive, Uncasville, CT 06382 | 2006-12-04 |
| 1659459584 | Rachel Elizabeth Vitello | Occupational Therapist | 303 Norwich New London Turnpike, Uncasville, CT 06382 | 2006-11-01 |
| 1093739310 | Regina Ann Strand | Optometrist | 2020 Norwich New London Turnpike, Unit 8, Uncasville, CT 06382 | 2006-07-27 |
| 1225096084 | Ronald Miner Hughes | Social Worker | 20 Maple Ave, Montville, CT 06382 | 2006-05-02 |
| 1184690703 | Peter S Hahn | Internal Medicine | 2020 Norwich New London Tpke Ste 12, Uncasville, CT 06382 | 2006-02-24 |
| Find all providers in zip 06382 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| City | UNCASVILLE |
| Zip Code | 06382 |
Please comment or provide details below to improve the information on MOHEGAN TRIBE OF INDIANS OF CT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.