Healthcare Provider Details

I. General information

NPI: 1922781616
Provider Name (Legal Business Name): ESSEX URGENT & PRIMARY CARE PROVIDERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ESSEX WAY STE 116
ESSEX VT
05452-3386
US

IV. Provider business mailing address

34 BLAIR PARK RD # 264
WILLISTON VT
05495-7991
US

V. Phone/Fax

Practice location:
  • Phone: 802-851-8750
  • Fax: 802-851-8765
Mailing address:
  • Phone: 850-797-0754
  • 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: DR. LOGAN TERESA PORTER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 802-851-8750