Mohegan Tribe of Indians of Connecticut

Primary specialty

AmbulanceTaxonomy code 341600000X

License

C086P1

Legal business name

MOHEGAN TRIBE OF INDIANS OF CONNECTICUT

Practice address

13 Crow Hill Rd
Uncasville, CT 06382-1118

Phone

(860) 862-6110

Fax

(860) 862-6140

NPI assigned

Oct 26, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Mary T Gentile

Title

Authorized Agent

Phone

(860) 257-9201

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mohegan Tribal Council Former legal business name

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Tax ID family

Mohegan Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mohegan Tribe of Indians of CT

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Uncasville, CT
  • NPI 1326313677
  NPD tax ID

Locations

Practitioners 1

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

• Khristine S Lariviere, RPH

  • Pharmacist
  • Uncasville, CT
  • NPI 1912273194
  NPD

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560902400000",
    "number": "1467442863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290184",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061290184",
            "telephone_number": "860-257-9201",
            "fax_number": "860-721-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 CROW HILL RD",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063821118",
            "telephone_number": "860-862-6110",
            "fax_number": "860-862-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHEGAN TRIBE OF INDIANS OF CONNECTICUT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2019-06-19",
        "status": "A",
        "authorized_official_last_name": "GENTILE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "860-257-9201",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": "C086P1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004185428",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590012782",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohegan Tribal Council",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Michael Scott McKay, DMD
• Jessica McKeever, CCC-SLP
• Timothy McKenna, PHARMD
• Bethany Luciani Miller, PA-C
• MLM Chiropractic LLC
• Mohegan Tribe of Indians of CT
• Montville Fire Company 1 Inc
• Carolyn Moody
• Paqui D Motyl, MD
• Murphy Chiropractic LLC

• Ambulance in Uncasville, CT
• Providers in Uncasville, CT by specialty
• Ambulance in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.