Basic Information
| Provider Information | |||||||||
| NPI: | 1780758219 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ATG CONNECTICUT INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NUMOTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2070 LITTLE HILLS EXPY | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633013708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144477500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 65 INWOOD RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060673440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607610700 | ||||||||
| FaxNumber: | 8607610750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING AND LICENSURE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3144477515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 799116-5637 | 01 | CT | CONNECTICARE | OTHER | 10042412 | 01 | CAPITOL DISTRICT PHY HP | OTHER | 81194 | 01 | CT | NORTHWOOD NPN | OTHER | ANC1783 | 01 | OXFORD HEALTH PLANS | OTHER | 642264 | 01 | CT | VOCATIONAL EDUCATIONAL | OTHER | 1168762 | 01 | CT | AETNA | OTHER | 12DME0165CT01 | 01 | BC BS -FEDERAL | OTHER | 419738200 | 01 | CT | BLUE CARE FAMILY PLAN | OTHER | 12DME0165CT01 | 01 | CT | BC BS CONNECTICUT | OTHER | 0V7875 | 01 | CT | HEALTHNET | OTHER | 4197382 | 05 | CT | MEDICAID | 4295 | 01 | CT | MOHAWK VALLEY PHY HEALTHP | OTHER |