Healthcare Provider Details

I. General information

NPI: 1295151934
Provider Name (Legal Business Name): CONNECTICUT URGENT CARE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 BERLIN RD
CROMWELL CT
06416-2627
US

IV. Provider business mailing address

136 BERLIN RD
CROMWELL CT
06416-2627
US

V. Phone/Fax

Practice location:
  • Phone: 860-378-8585
  • Fax: 860-378-8586
Mailing address:
  • Phone: 860-378-8585
  • Fax: 860-378-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0739
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateCT

VIII. Authorized Official

Name: LINDA K GALLACHER
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-378-8585