Healthcare Provider Details

I. General information

NPI: 1821411828
Provider Name (Legal Business Name): URGENT CARE OF GROTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ROUTE 12 SUITE 16 & 17
GROTON CT
06340-3414
US

IV. Provider business mailing address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

V. Phone/Fax

Practice location:
  • Phone: 203-885-0808
  • Fax: 203-885-0813
Mailing address:
  • Phone: 203-885-0808
  • Fax: 203-885-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RALPH ROBERT ROHATSCH
Title or Position: CEO
Credential: MD
Phone: 203-885-0808