Healthcare Provider Details

I. General information

NPI: 1134250541
Provider Name (Legal Business Name): INHEALTH MED CT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 QUARRY ST
WILLIMANTIC CT
06226
US

IV. Provider business mailing address

37 IVAN HILL ST
WILLIMANTIC CT
06226-2001
US

V. Phone/Fax

Practice location:
  • Phone: 860-423-8020
  • Fax: 860-456-8288
Mailing address:
  • Phone: 860-423-8020
  • Fax: 860-456-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number019026
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001754
License Number StateCT

VIII. Authorized Official

Name: EDMUND WEST
Title or Position: OWNER
Credential: MD
Phone: 860-423-8020