Healthcare Provider Details

I. General information

NPI: 1710191135
Provider Name (Legal Business Name): PLAINFIELD WALK IN MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 NORWICH RD
PLAINFIELD CT
06374-1725
US

IV. Provider business mailing address

558 NORWICH RD
PLAINFIELD CT
06374-1725
US

V. Phone/Fax

Practice location:
  • Phone: 860-564-4054
  • Fax: 860-564-0354
Mailing address:
  • Phone: 860-564-4054
  • Fax: 860-564-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier001379199
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier010037919CT01
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: DR. LEAH BRIONES
Title or Position: OWNER
Credential: M.D.
Phone: 860-564-4054