Healthcare Provider Details

I. General information

NPI: 1679026397
Provider Name (Legal Business Name): CTUC02 URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BOULEVARD
WEST HARTFORD CT
06119-1801
US

IV. Provider business mailing address

1030 BOULEVARD
WEST HARTFORD CT
06119-1801
US

V. Phone/Fax

Practice location:
  • Phone: 860-986-6440
  • Fax:
Mailing address:
  • Phone: 860-986-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number047019
License Number StateCT

VIII. Authorized Official

Name: DR. IFTIKHAR ALI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 860-986-6440