Healthcare Provider Details

I. General information

NPI: 1558661025
Provider Name (Legal Business Name): NEW ENGLAND URGENT CARE ENFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N MAIN ST SUITE B
WEST HARTFORD CT
06107-1939
US

IV. Provider business mailing address

21 N MAIN ST SUITE B
WEST HARTFORD CT
06107-1939
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-3911
  • Fax: 860-236-3901
Mailing address:
  • Phone: 860-236-3911
  • Fax: 860-236-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL B GUTMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 860-236-3911