Healthcare Provider Details

I. General information

NPI: 1548804628
Provider Name (Legal Business Name): URGENT CARE OF WEST HARTFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 1339
GLASTONBURY CT
06033-6339
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-3911
  • Fax:
Mailing address:
  • Phone: 860-650-3848
  • Fax:

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 KENKARE
Title or Position: CMO
Credential: MD
Phone: 203-616-4440