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General NPI Number Information
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NPI Number | 1043852569
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Entity Type | Organization
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Legal Business Name | ST. VINCENTS URGENT CARE LLC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 900 WHITE PLAINS RD
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City | TRUMBULL
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State | CT
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Zip | 06611-5727
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Country | US
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Telephone | 203-696-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5363
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Country | US
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Telephone | 475-210-5346
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MS. LLATOYA GAYLE
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Credential |
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Telephone | 475-210-5346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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