NPIMap

Organization Active NPI

Town of Stratford Health Dept.

  • Student Health Clinic/Center
  • Stratford, CT
National Provider Identifier
1114074606
Registry record updated Jan 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
License
0252 Issued in CT
Legal business name
TOWN OF STRATFORD HEALTH DEPT.
Doing business as
Wooster School Based Health Center
Practice address
150 Lincoln St
Stratford, CT 06614-4000
Phone
(203) 381-6922
Fax
(203) 381-6923
NPI assigned
Jan 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Greta Broneill, MPH
Title
Project Coordinator
Phone
(203) 381-6922

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Student Health Clinic/Center 261QS1000X 0252 CT Primary

Addresses

Primary practice location

150 Lincoln St
Stratford, CT 06614-4000

Mailing address

150 Lincoln St
Stratford, CT 06614-4000
Phone (203) 381-6922

Other identifiers 1

IdentifierTypeStateIssuer
004144573MedicaidCT

Other names 1

  • Wooster School Based Health Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2075920Town of Stratford Wooster School Based HLTH Center150 Lincoln Ave, Stratford, CT 06614Certificate of waiverApr 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Stratford Health Depart5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

150 Lincoln St
Stratford, CT 06614
Phone (203) 381-6922

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1114074606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 LINCOLN ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066144000",
            "telephone_number": "203-381-6922",
            "fax_number": "203-381-6923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 LINCOLN ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066144000",
            "telephone_number": "203-381-6922",
            "fax_number": "203-381-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF STRATFORD HEALTH DEPT.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "BRONEILL",
        "authorized_official_first_name": "GRETA",
        "authorized_official_title_or_position": "PROJECT COORDINATOR",
        "authorized_official_telephone_number": "203-381-6922",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "CT",
            "license": "0252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004144573",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wooster School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stratford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.