OrganizationActive
US Navy
NPI 1750631685 · Exclusive Provider Organization · Groton, CT
Provider details
- NPI number
- 1750631685
- Entity type
- Organization
- Primary specialty
- Exclusive Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Ismael Lopez, Sub Idc(361) 522-5925
Specialties & taxonomies
Managed Care Organizations
Practice location
207 Hickory Dr
Groton, CT 06340-2946
Phone: (361) 522-5925
Approximate (ZIP-level) locationGet directions
Mailing address
207 Hickory Dr
Groton, CT 06340-2946
Registry dates
- Enumerated
- 2012-09-18
- Last updated
- 2012-09-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.