MOHEGAN TRIBE OF INDIANS OF CT; NPI #1326313677

Contact Information

MOHEGAN TRIBE OF INDIANS OF CT

67 SANDY DESERT RD
UNCASVILLE, CT 06382-1111

Phone: 855-664-4679
Fax: 860-862-9099
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy	332800000X	87	All Other Suppliers

Indicates primary specialty

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NPI Profile & details for MOHEGAN TRIBE OF INDIANS OF CT

NPI # 1326313677

LBN Legal business name MOHEGAN TRIBE OF INDIANS OF CT

Authorized official DEBRA MAXEINER - (DEPUTY CHIEF OF STAFF, OPS&ADMIN)

Entity Organization

Organization subpart ¹ No

Enumeration date 03/20/2012

Last updated 06/18/2019 - About 7 years ago

Identifiers

AL	License #	114286
CA	License #	NRP-1530
CO	License #	OSP.0006230
CT	License #	PCY.0001934
DC	License #	NRX0000432
FL	License #	PH26952
GA	License #	PHNR001180
HI	License #	PMP-959
IL	License #	54.018477
KS	License #	22-102271
LA	License #	PHY.007550-NR
ME	License #	MO40001384
MO	License #	2013044792
MS	License #	14964/7.1
MT	License #	PHA-MOP-LIC-25328
	Other	2135247	PK

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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MOHEGAN TRIBE OF INDIANS OF CT

Contact Information

Specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

NPI Profile & details for MOHEGAN TRIBE OF INDIANS OF CT

Reviews for MOHEGAN TRIBE OF INDIANS OF CT