| Mashantucket Pequot Tribal Council | |
|
75 Route 2 Ledyard CT 06339-1128 | |
| (860) 312-8000 | |
| (860) 312-8001 |
| Full Name | Mashantucket Pequot Tribal Council |
|---|---|
| Speciality | Family Medicine |
| Location | 75 Route 2, Ledyard, Connecticut |
| Authorized Official Name and Position | Shanna Tari Reels (TRIBAL HEALTH SERVICES DIRECTOR) |
| Authorized Official Contact | 8603128014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mashantucket Pequot Tribal Council Po Box 3260 75 Rt 2 Mashantucket CT 06339-3260 Ph: (860) 312-8000 | Mashantucket Pequot Tribal Council 75 Route 2 Ledyard CT 06339-1128 Ph: (860) 312-8000 |
| NPI Number | 1508140922 |
|---|---|
| Provider Enumeration Date | 10/04/2011 |
| Last Update Date | 09/09/2014 |
| Medicare PECOS PAC ID | 8628295599 |
|---|---|
| Medicare Enrollment ID | O20140818000464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508140922 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Dwala M Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346628088 PECOS PAC ID: 3274822630 Enrollment ID: I20160525001521 |
| Provider Name | Crystal Roach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194254144 PECOS PAC ID: 4587902358 Enrollment ID: I20190221000349 |
| Provider Name | Nancy G Miner |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1487772943 PECOS PAC ID: 7911994397 Enrollment ID: I20190312000084 |
| Provider Name | Rosemary Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497188593 PECOS PAC ID: 8426434176 Enrollment ID: I20221017000180 |
| Provider Name | Shanaaz Shameen Mohammed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245426626 PECOS PAC ID: 9032362660 Enrollment ID: I20230203001423 |
| Provider Name | Yvette Dionne |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1376677526 PECOS PAC ID: 6901709591 Enrollment ID: I20230427001096 |
| Provider Name | Diane S Morgenthaler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578708111 PECOS PAC ID: 8921447269 Enrollment ID: I20240418003167 |
Mashantucket Pequot Tribal Nation Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 75 Route 2, Ledyard, CT 06339 Phone: 860-321-8000 Fax: 860-321-4883 | |
Child And Family Agency Of Southeastern Connecticut, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 24 Gallup Hill Rd, Ledyard, CT 06339 Phone: 860-437-4550 Fax: 860-661-4262 |