Healthcare Provider Details

I. General information

NPI: 1194489583
Provider Name (Legal Business Name): UC OF SOUTHINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 QUEEN ST
SOUTHINGTON CT
06489-1884
US

IV. Provider business mailing address

2928 MAIN ST STE 101
GLASTONBURY CT
06033-1007
US

V. Phone/Fax

Practice location:
  • Phone: 855-349-2828
  • Fax:
Mailing address:
  • Phone: 860-430-1246
  • Fax: 860-656-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEANNIE M KENKARE
Title or Position: CMO
Credential: DO
Phone: 203-616-4440