MASHANTUCKET PEQUOT TRIBAL NATION HEALTH CENTER (NPI# 1508170556) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508170556 |
| Entity Type | Organization |
| Organization Name | MASHANTUCKET PEQUOT TRIBAL NATION HEALTH CENTER |
| Practice Address |
75 Route 2 Ledyard CT 06339-1128 |
| Mailing Address |
75 Route 2 Po Box 3260 Mashantucket CT 06338-3260 |
| Practice Telephone | 8603218000 |
| Practice Fax Number | 8603214883 |
| Mailing Telephone | 8603218000 |
| Mailing Fax Number | 8603124883 |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2010-08-02 |
| Authorized Official Name | MR. RODNEY A BUTLER (TRIBAL COUNCIL CHAIRMAN) |
| Authorized Official Telephone | 8603966133 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
75 ROUTE 2 |
| City | LEDYARD |
| State | CT |
| Zip Code | 06339-1128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003965450 | Sandra Berardy | Nurse Practitioner | 75 Route 2, Mashantucket Pequot Indian Health Services, Ledyard, CT 06339 | 2007-01-08 |
| 1508140922 | Mashantucket Pequot Tribal Council | Family Medicine | 75 Route 2, Ledyard, CT 06339-1128 | 2011-10-04 |
| 1366561508 | Patricia A Dubose | Internal Medicine | 75 Route 2, Ledyard, CT 06339-1128 | 2007-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538404728 | Michael Christopher Kendig | Veterinarian | 5 Lorenz Industrial Parkway, Ledyard, CT 06339 | 2012-11-29 |
| 1720342850 | Alyson King Gannon | Physician Assistant | 2 Lorenz Pkwy, Backus Health Center, Ledyard, CT 06339 | 2012-07-03 |
| 1265798524 | Kenneth Warren Berdeen II | Occupational Therapy Assistant | 220 Haley Rd, Ledyard, CT 06339 | 2012-04-11 |
| 1427257054 | Caitlyn Elizabeth Ogilvie | Social Worker | 24 Gallup Hill Rd, Ledyard, CT 06339 | 2007-07-13 |
| 1013093434 | Joy Holistic Counseling LLC | Social Worker | 1807 Center Groton Rd, Ledyard, CT 06339 | 2006-10-27 |
| 1972687952 | Linda R Kronick | Dentist | 77 Salem Turnpike, Suite 112, Norwich, CT 06339 | 2006-10-25 |
| 1245225887 | Town of Ledyard | Ambulance | 741 R Col Ledyard Highway, Ledyard, CT 06339 | 2005-09-20 |
| 1841338332 | Barbara Jean Savage | Social Worker | 1807 Center Groton Rd, Ledyard, CT 06339 | 2007-02-05 |
| 1134192420 | Joel Patrick Larose | Nurse Anesthetist, Certified Registered | 2 Oak Hills Trl, Ledyard, CT 06339-1234 | 2006-02-08 |
| 1790785905 | Jay Clark Hans | Audiologist | 7 Coachman Pike, Ledyard, CT 06339-1305 | 2005-07-29 |
| Find all providers in zip 06339 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1265039093 | Thrive Haven LLC | Clinic/Center | 195 James St Fl 1, New Haven, CT 06513-3847 | 2020-10-05 |
| 1083229165 | Kusher Functional Medicine Center PC | Clinic/Center | 76 Eastern Blvd Ste 103, Glastonbury, CT 06033-4382 | 2020-09-15 |
| 1609414176 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 154 Toll Gate Rd, Groton, CT 06340-3444 | 2019-12-16 |
| 1811532500 | Alpha Wave Health Centers LLC | Clinic/Center | 10 Waterside Dr Ste 101, Farmington, CT 06032-3056 | 2019-11-17 |
| 1093282360 | Tms Neurohealth Pllc | Clinic/Center | 728 Post Rd E Ste 202, Westport, CT 06880-5200 | 2018-10-25 |
| 1982179784 | Wellness Primary Care Pllc | Clinic/Center | 291 S Lambert Rd Ste 5, Orange, CT 06477-3559 | 2018-10-08 |
| 1366953705 | Connecticut Neurodiagnostics, LLC | Clinic/Center | 83 Wooster Heights Rd., Suite 125, Office 145, Danbury, CT 06810 | 2017-10-12 |
| 1366993214 | Ascension Naturopathic Healing Center LLC | Clinic/Center | 175 Boston Post Road, Floor 1, Waterford, CT 06385 | 2016-10-16 |
| 1235588625 | Family Centers Inc. | Clinic/Center | 1 Wilbur Peck Ct Lowr Level, Greenwich, CT 06830-6354 | 2016-06-07 |
| 1578926424 | Chiropractic Wellness Center | Clinic/Center | 75 Hazard Ave Unit I, Enfield, CT 06082-3887 | 2016-03-29 |
| Find all providers with the same taxonomy | ||||
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| 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.