Healthcare Provider Details

I. General information

NPI: 1255752945
Provider Name (Legal Business Name): AFC PHYSICIANS OF CONNECTICUT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BOULEVARD
WEST HARTFORD CT
06119
US

IV. Provider business mailing address

1030 BOULEVARD
WEST HARTFORD CT
06119
US

V. Phone/Fax

Practice location:
  • Phone: 860-986-6440
  • Fax: 203-826-2139
Mailing address:
  • Phone: 860-986-6440
  • Fax: 860-986-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCT

VIII. Authorized Official

Name: MR. THOMAS KELLY
Title or Position: PRESIDENT
Credential:
Phone: 860-986-6440