NPIMap

Organization Active NPI

City of Bridgeport Health Dept. School Based Health Center

  • Health Service Clinic/Center
  • Bridgeport, CT
National Provider Identifier
1841319803
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
CITY OF BRIDGEPORT HEALTH DEPT. SCHOOL BASED HEALTH CENTER
Doing business as
Roosevelt Elementary School Based Health Center
Practice address
680 Park Ave
Bridgeport, CT 06604-4610
Phone
(203) 576-8090
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mirian Evans
Title
Director of Health
Phone
(203) 576-7680

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

680 Park Ave
Bridgeport, CT 06604-4610

Mailing address

752 E Main St
Bridgeport, CT 06608-2335
Phone (203) 576-8090

Other names 1

  • Roosevelt Elementary School Based Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Hygiene Division14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

680 Park Ave
Bridgeport, CT 06604
Phone (203) 576-8090

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841319803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "752 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066082335",
            "telephone_number": "203-576-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044610",
            "telephone_number": "203-576-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF BRIDGEPORT HEALTH DEPT. SCHOOL BASED HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MIRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH",
        "authorized_official_telephone_number": "203-576-7680",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roosevelt Elementary School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.