Healthcare Provider Details

I. General information

NPI: 1134665698
Provider Name (Legal Business Name): BLOOMFIELD URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MOUNTAIN AVE
BLOOMFIELD CT
06002-2339
US

IV. Provider business mailing address

16 MOUNTAIN AVE
BLOOMFIELD CT
06002-2339
US

V. Phone/Fax

Practice location:
  • Phone: 860-205-3544
  • Fax:
Mailing address:
  • Phone: 860-205-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEPHEN A KEI
Title or Position: OWNER
Credential: MD
Phone: 860-205-3544